Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 23466 | TN |
N | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 23466 | TN |
NPI | 1013426717 |
---|---|
Provider Name | Marshall Fife |
First Address | Nashville, TN 37203-1582 |
Second Address | Nashville, TN 37228-1805 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2017 |
Last Update Date | 04/01/2022 |