Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RE0101X | Endocrinologist (Diabetes Doctor) | 2006-00072 | NC |
N | 208000000X | Pediatrician | 2006-00072 | NC |
N | 2080P0205X | Pediatric Endocrinologist | 2006-00072 | NC |
Y | 2080P0205X | Pediatric Endocrinologist | 63474 | TN |
NPI | 1508929373 |
---|---|
Provider Name | Evelyn Artz |
First Address | Johnson City, TN 37604-2579 |
Second Address | Johnson City, TN 37604-6088 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2006 |
Last Update Date | 27/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5903260 | (05) | NC |
H55214 | (02) | |
Q067488 | (05) | TN |