Healthcare Provider Details

I. General information

NPI: 1275779191
Provider Name (Legal Business Name): PROFESSIONAL SUPPORTIVE NURSING CARE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2008
Last Update Date: 12/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

631 POPLAR RIDGE RD
CHAPMANSBORO TN
37035-5338
US

IV. Provider business mailing address

631 POPLAR RIDGE RD
CHAPMANSBORO TN
37035-5338
US

V. Phone/Fax

Practice location:
  • Phone: 615-509-3613
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: MS. SYLVIA DANA COOPER
Title or Position: DIRECTOR/OWNER
Credential: RN
Phone: 615-509-3613