Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | RN110225 | TN |
NPI | 1013912310 |
---|---|
Provider Name | James N Brenner |
First Address | Nashville, TN 37205-1444 |
Second Address | Nashville, TN 37205-1444 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2005 |
Last Update Date | 23/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
410-1956 | BCBS (01) | TN |
P18736 | (02) |