Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 23221 | TN |
NPI | 1053820654 |
---|---|
Provider Name | Jennifer Anne Shelby |
First Address | Murfreesboro, TN 37129-2586 |
Second Address | Murfreesboro, TN 37129-2586 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2017 |
Last Update Date | 26/09/2017 |