Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 2538 | TN |
NPI | 1164072575 |
---|---|
Provider Name | Miss Rebecca Lee Redmond |
First Address | Mc Kenzie, TN 38201-1736 |
Second Address | Mc Kenzie, TN 38201-1736 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2019 |
Last Update Date | 17/09/2019 |