Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YP0228X | Pediatric Otolaryngology | 436967 | PA |
NPI | 1003890807 |
---|---|
Provider Name | Dr. Jennifer Dawn Mclevy-Bazzanella |
First Address | Memphis, TN 38105-4625 |
Second Address | Memphis, TN 38105-4625 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2005 |
Last Update Date | 02/11/2015 |