Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 028791 | TN |
NPI | 1073580932 |
---|---|
Provider Name | Lenette Perra |
First Address | Knoxville, TN 37909-2604 |
Second Address | Knoxville, TN 37916-1809 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2006 |
Last Update Date | 28/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G57616 | (02) | TN |