Healthcare Provider Details

I. General information

NPI: 1114937430
Provider Name (Legal Business Name): LAURA F. MUIR CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA MARIE FASS

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 04/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2018 WESTERN AVE
KNOXVILLE TN
37921-5718
US

IV. Provider business mailing address

6350 W ANDREW JOHNSON HWY
TALBOTT TN
37877-8605
US

V. Phone/Fax

Practice location:
  • Phone: 865-544-0406
  • Fax: 865-544-0480
Mailing address:
  • Phone: 800-355-3565
  • Fax: 423-714-2355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAPN7684
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: