Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | APN0000008186 | TN |
NPI | 1003813023 |
---|---|
Provider Name | Mrs. Katrina H Denegri |
First Address | Memphis, TN 38182-0406 |
Second Address | Memphis, TN 38104-6426 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3908110 | (05) | TN |
P77563 | (02) | TN |