Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | APN6443 | TN |
NPI | 1124229190 |
---|---|
Provider Name | Colleen Flanders |
First Address | Cookeville, TN 38501-2435 |
Second Address | Cookeville, TN 38501-4294 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2007 |
Last Update Date | 15/05/2017 |