Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | DS8136 | TN |
N | 1223G0001X | General Practice | 8136 | TN |
N | 213EG0000X | General Practice | 8136 | TN |
NPI | 1275611600 |
---|---|
Provider Name | Dr. Delia Fernandez |
First Address | Mt. Pleasant, TN 38474 |
Second Address | Mt. Pleasant, TN 38474 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2006 |
Last Update Date | 12/02/2016 |