Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 22432 | TN |
N | 363LP2300X | Nurse Practitioner - Primary Care | 22432 | TN |
NPI | 1073046751 |
---|---|
Provider Name | Shannon Lea Robbins |
First Address | Crossville, TN 38555-1915 |
Second Address | Crossville, TN 38555-4470 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2017 |
Last Update Date | 27/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Q028045 | (05) | TN |