Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 23091 | TN |
NPI | 1003335688 |
---|---|
Provider Name | Lauren Fox |
First Address | Chattanooga, TN 37415-3954 |
Second Address | Chattanooga, TN 37403-2101 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2017 |
Last Update Date | 14/01/2019 |