Healthcare Provider Details

I. General information

NPI: 1730317249
Provider Name (Legal Business Name): AMELIE FERNANDEZ RUAZOL BLUE LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2009
Last Update Date: 10/18/2023
Certification Date: 10/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

KNOXVILLE VA MEDICAL CENTER 1557 DOWNTOWN WEST BLVD
KNOXVILLE TN
37919
US

IV. Provider business mailing address

KNOXVILLE VA MEDICAL CENTER 1557 DOWNTOWN WEST BLVD
KNOXVILLE TN
37919
US

V. Phone/Fax

Practice location:
  • Phone: 865-545-4592
  • Fax:
Mailing address:
  • Phone: 865-545-4592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number4788
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: