Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TH0100X | Health Service | 1-18-30687 | TN |
NPI | 1073100160 |
---|---|
Provider Name | Laura Trillizio |
First Address | Mount Juliet, TN 37122-7412 |
Second Address | Mount Juliet, TN 37122-7412 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/12/2020 |
Last Update Date | 23/12/2020 |