Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 01074837 | IN |
Y | 2080P0203X | Pediatric Critical Care Doctor | 35.127907 | OH |
NPI | 1043576770 |
---|---|
Provider Name | Julie Elizabeth Stark |
First Address | Nashville, TN 37204-4701 |
Second Address | Nashville, TN 37232-3026 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2012 |
Last Update Date | 15/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201095350 | (05) | IN |