Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 24641 | TN |
NPI | 1013488519 |
---|---|
Provider Name | Erin Richmond Borum |
First Address | Knoxville, TN 37912-2747 |
Second Address | Sevierville, TN 37862-6079 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/12/2018 |
Last Update Date | 06/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Q045796 | (05) | TN |