Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | APN000026424 | TN |
NPI | 1003457409 |
---|---|
Provider Name | Leven Ward |
First Address | Medina, TN 38355-8941 |
Second Address | Medina, TN 38355-8941 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/10/2019 |
Last Update Date | 07/10/2019 |