Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 30623 | TN |
NPI | 1134885296 |
---|---|
Provider Name | Victoria Layne Burris |
First Address | Alcoa, TN 37701-1808 |
Second Address | Knoxville, TN 37920-1511 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/11/2021 |
Last Update Date | 12/11/2021 |