Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | APN0000010829 | TN |
NPI | 1023042298 |
---|---|
Provider Name | Eddie Jean Truelove |
First Address | Memphis, TN 38115-4299 |
Second Address | Memphis, TN 38115-4299 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 20/08/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3642147 | (05) | TN |
4136506 | BLUE CROSS BLUE SHIELD (01) | TN |
P00609180 | RAILROAD MEDICARE (01) | TN |
Q59847 | (02) |