Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 4168 | TN |
NPI | 1255545828 |
---|---|
Provider Name | Mrs. Janet Lynn Coleman |
First Address | Knoxville, TN 37912-1107 |
Second Address | Knoxville, TN 37922-3383 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2007 |
Last Update Date | 08/07/2007 |