Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 20697 | TN |
NPI | 1043676851 |
---|---|
Provider Name | Miss Megan Dorothy Breyer |
First Address | Cookeville, TN 38501-2422 |
Second Address | Cookeville, TN 38501-2422 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2016 |
Last Update Date | 08/01/2016 |