Healthcare Provider Details

I. General information

NPI: 1841825940
Provider Name (Legal Business Name): MRS. RUTHIE OTULANA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2020
Last Update Date: 03/09/2020
Certification Date: 03/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4041 KNIGHT ARNOLD RD
MEMPHIS TN
38118-2128
US

IV. Provider business mailing address

8310 BOGEY DR APT 106
MEMPHIS TN
38125-5318
US

V. Phone/Fax

Practice location:
  • Phone: 901-572-1573
  • Fax:
Mailing address:
  • Phone: 901-495-0148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: