Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0207X | Pediatric Hematology-Oncologist | 2580 | TN |
N | 2080P0207X | Pediatric Hematology-Oncologist | 4346 | OK |
NPI | 1023093986 |
---|---|
Provider Name | Wendy Bourland |
First Address | Memphis, TN 38105-3678 |
Second Address | Memphis, TN 38105-3678 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2005 |
Last Update Date | 06/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H46866 | (02) | OK |