Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 1150 | TN |
NPI | 1093926255 |
---|---|
Provider Name | Sherry Jo Woolverton-Jones |
First Address | Humboldt, TN 38343-3054 |
Second Address | Humboldt, TN 38343-3054 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2007 |
Last Update Date | 08/07/2007 |