Healthcare Provider Details

I. General information

NPI: 1841383544
Provider Name (Legal Business Name): MARY K ELWOOD FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 05/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 N MAIN ST SUITE 2
GREENEVILLE TN
37745-5033
US

IV. Provider business mailing address

1225 E WEISGARBER RD SUITE 200
KNOXVILLE TN
37909-2604
US

V. Phone/Fax

Practice location:
  • Phone: 423-639-2161
  • Fax:
Mailing address:
  • Phone: 865-584-4747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number10472
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: