Healthcare Provider Details

I. General information

NPI: 1972224368
Provider Name (Legal Business Name): ELIZABETH GRACE ESCOLAR RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2022
Last Update Date: 09/06/2022
Certification Date: 09/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

541 MATT EDMOND RD
HARRIMAN TN
37748-3430
US

IV. Provider business mailing address

541 MATT EDMOND RD
HARRIMAN TN
37748-3430
US

V. Phone/Fax

Practice location:
  • Phone: 865-900-6714
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number244974
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: