Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist |
NPI | 1316415987 |
---|---|
Provider Name | Juliette Primm |
First Address | Mount Juliet, TN 37122-3295 |
Second Address | Mount Juliet, TN 37122-3295 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/11/2018 |
Last Update Date | 12/11/2018 |