Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 47839 | TN |
Y | 2080P0214X | Pediatric Pulmonologist | 47839 | TN |
NPI | 1346465358 |
---|---|
Provider Name | Lana Jeradeh Boursoulian |
First Address | Nashville, TN 37204-4701 |
Second Address | Nashville, TN 37232-5048 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2007 |
Last Update Date | 12/03/2021 |