Healthcare Provider Details

I. General information

NPI: 1215290523
Provider Name (Legal Business Name): ELIZABETH PUHR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2012
Last Update Date: 06/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6526 STILL MEADOWS LANE
HARRISON TN
37341
US

IV. Provider business mailing address

6526 STILL MEADOWS LANE
HARRISON TN
37341
US

V. Phone/Fax

Practice location:
  • Phone: 334-750-3143
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number175666
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: