Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | 23101 | TN |
NPI | 1710476270 |
---|---|
Provider Name | Dondrea Bostick |
First Address | Knoxville, TN 37920-3257 |
Second Address | Knoxville, TN 37920-3257 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2018 |
Last Update Date | 09/05/2018 |