MEDICARE: MRS. DARA ELIZABETH PIEDRA

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
1	172A00000X	Driver	11963909	TN
2	172A00000X	Driver	094496586	TN

General Provider Information

NPI Number	:	1689381766
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DARA ELIZABETH PIEDRA

Provider Business Mailing Address
First Line	:	1816 BELL TOWER LN NE
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37312-2591
Country	:	US
Telephone Number	:	423-413-3234
Fax Number	:

Provider Business Practice Location Address
First Line	:	1816 BELL TOWER LN NE
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37312-2591
Country	:	US
Telephone Number	:	423-413-3234
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/31/2022
Last Update Date	:	10/31/2022

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