Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LP0200X | Nurse Practitioner - Pediatrics | APN0000005409 | TN |
NPI | 1013911007 |
---|---|
Provider Name | Nan M. Gaylord |
First Address | Knoxville, TN 37996-4180 |
Second Address | Knoxville, TN 37915-1415 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2005 |
Last Update Date | 03/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3497038 | (05) | TN |