Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 175F00000X | Naturopath | ||
Y | 207Q00000X | Family Doctor | 178.361 | ZZ |
NPI | 1063860617 |
---|---|
Provider Name | Virginia Leon Debermudez |
First Address | Clarksville, TN 37043-6741 |
Second Address | Clarksville, TN 37043-6741 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2016 |
Last Update Date | 21/12/2016 |