Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | APN0000007478 | TN |
NPI | 1043304256 |
---|---|
Provider Name | Ms. Marilyn Follett Konkel |
First Address | Ooltewah, TN 37363-8661 |
Second Address | Ooltewah, TN 37363-8661 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 08/07/2007 |