Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 12959 | TN |
NPI | 1104817667 |
---|---|
Provider Name | Dr. Janet L Dittus |
First Address | Goodlettsville, TN 37072-3132 |
Second Address | Nashville, TN 37203-1835 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2005 |
Last Update Date | 10/05/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0066972 | BCBS (01) | TN |
3002542 | (05) | TN |
6031178 | BCBS TN (01) | TN |
A96776 | (02) |