Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 28536 | TN |
N | 363LW0102X | Nurse Practitioner - Women's Health | RN248691 | GA |
NPI | 1053913160 |
---|---|
Provider Name | Rachel Stuckey Easterwood |
First Address | Dalton, GA 30720-8379 |
Second Address | Chattanooga, TN 37403-2800 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/11/2020 |
Last Update Date | 03/02/2021 |