Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 19489 | TN |
NPI | 1023088721 |
---|---|
Provider Name | Michelle Lanter Brewer |
First Address | Knoxville, TN 37919 |
Second Address | Knoxville, TN 37919 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2006 |
Last Update Date | 06/07/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3043811 | (05) | TN |
E04257 | (02) |