Healthcare Provider Details

I. General information

NPI: 1124366513
Provider Name (Legal Business Name): DAVID A FERRARO LPN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2013
Last Update Date: 01/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 NEAL ST
COOKEVILLE TN
38501-0901
US

IV. Provider business mailing address

4398 ENSOR HOLLOW RD
BUFFALO VALLEY TN
38548-5432
US

V. Phone/Fax

Practice location:
  • Phone: 931-528-8593
  • Fax:
Mailing address:
  • Phone: 931-319-3206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number81678
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: