Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 25984 | TN |
N | 207NS0135X | Procedural Dermatology | 25984 | TN |
NPI | 1407952559 |
---|---|
Provider Name | Mrs. Lynn M Foley |
First Address | Germantown, TN 38138-3830 |
Second Address | Germantown, TN 38138-3830 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2006 |
Last Update Date | 15/12/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003011068 | BCBS (01) | TN |
C15635 | (02) | TN |