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NPI Code Detail

MEDICARE: MS. CYNTHIA FOGG ESLICK RN

MEDICARE: MS. CYNTHIA FOGG ESLICK RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered NurseRN0000080655TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1RN0000080655OTHERTNTENNESSEE STATE LICENSE N

General Provider Information

NPI Number : 1497881395
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. CYNTHIA FOGG ESLICK RN
Provider Business Mailing Address
First Line : 444 CRYSTAL RIDGE RD
Second Line :
City : MULBERRY
State : TN
Zip : 37359-5126
Country : US
Telephone Number : 931-433-3231
Fax Number : 931-438-1567
Provider Business Practice Location Address
First Line : 1000 WASHINGTON ST W
Second Line : SUITE A
City : FAYETTEVILLE
State : TN
Zip : 37334-2872
Country : US
Telephone Number : 931-433-3231
Fax Number : 931-438-1567
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/26/2007
Last Update Date : 07/08/2007

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