Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 170100000X | Medical Geneticist | MD0000021338 | TN |
NPI | 1558330936 |
---|---|
Provider Name | Ilse J Anderson |
First Address | Knoxville, TN 37920-1511 |
Second Address | Knoxville, TN 37920-1511 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2006 |
Last Update Date | 05/03/2010 |