Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 19885 | TN |
NPI | 1003165838 |
---|---|
Provider Name | Heather Lynn Marks |
First Address | Franklin, TN 37068-1789 |
Second Address | Murfreesboro, TN 37129-2598 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2012 |
Last Update Date | 16/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Q019075 | (05) | TN |