Healthcare Provider Details

I. General information

NPI: 1891863189
Provider Name (Legal Business Name): LISA S TWYMAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 W FOREST AVE
JACKSON TN
38301-3901
US

IV. Provider business mailing address

54 DAVENPORT RD
HUMBOLDT TN
38343-6653
US

V. Phone/Fax

Practice location:
  • Phone: 731-935-8386
  • Fax:
Mailing address:
  • Phone: 731-787-7048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN0000070256
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: