Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 215 | TN |
Y | 222Z00000X | Podiatrist | 215 | TN |
N | 224P00000X | Prosthetist | 195 | TN |
NPI | 1316470883 |
---|---|
Provider Name | Mrs. Rachel Sidle |
First Address | Memphis, TN 38119-4878 |
Second Address | Memphis, TN 38119-4878 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2017 |
Last Update Date | 16/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
CPO 03218 | ABC (01) |