Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | 58450 | TN |
NPI | 1114184462 |
---|---|
Provider Name | Dr. Stacey Bourg Slagle |
First Address | Nashville, TN 37204-4701 |
Second Address | Nashville, TN 37232-5100 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2008 |
Last Update Date | 15/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201344080 | (05) | IN |