Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0207X | Pediatric Hematology-Oncologist | 12061 | TN |
NPI | 1114493095 |
---|---|
Provider Name | Gina Marie Norman |
First Address | Memphis, TN 38103-8846 |
Second Address | Memphis, TN 38105-3678 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2018 |
Last Update Date | 18/10/2018 |