Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | RN0000141617 | TN |
NPI | 1104242262 |
---|---|
Provider Name | Stephanie Huskins |
First Address | Ooltewah, TN 37363-6561 |
Second Address | Ooltewah, TN 37363-6561 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/03/2014 |
Last Update Date | 23/06/2016 |