Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 30468 | TN |
NPI | 1073278529 |
---|---|
Provider Name | Morgan Vantrease |
First Address | Chattanooga, TN 37403-2800 |
Second Address | Chattanooga, TN 37403-2800 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2021 |
Last Update Date | 01/11/2021 |