Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 0000016233 | TN |
NPI | 1013293463 |
---|---|
Provider Name | Sarah Brady |
First Address | Cookeville, TN 38501-2495 |
Second Address | Cookeville, TN 38501-2495 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2011 |
Last Update Date | 02/07/2012 |