Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 21336 | TN |
NPI | 1013462407 |
---|---|
Provider Name | Ariel Denton |
First Address | Johnson City, TN 37602-3889 |
Second Address | Johnson City, TN 37604-2364 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2016 |
Last Update Date | 08/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Q024831 | (05) | TN |