Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0210X | Pediatric Nephrologist | 18614 | TN |
NPI | 1205892353 |
---|---|
Provider Name | Dr. Bettina Ault |
First Address | Chattanooga, TN 37403-2101 |
Second Address | Chattanooga, TN 37403-2101 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2006 |
Last Update Date | 26/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3815047 | (05) | TN |
E67312 | (02) |