Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 13721 | TN |
NPI | 1033366646 |
---|---|
Provider Name | Juliet Gladson |
First Address | Knoxville, TN 37919-7360 |
Second Address | Knoxville, TN 37909-2706 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2008 |
Last Update Date | 11/01/2016 |