Healthcare Provider Details

I. General information

NPI: 1902480619
Provider Name (Legal Business Name): NASTASSIA LARIE ECHOLS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2021
Last Update Date: 05/09/2021
Certification Date: 05/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1265 UNION AVE
MEMPHIS TN
38104-3415
US

IV. Provider business mailing address

2865 EXECUTIVE DR
MEMPHIS TN
38115-1811
US

V. Phone/Fax

Practice location:
  • Phone: 901-901-5462
  • Fax:
Mailing address:
  • Phone: 901-590-9886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number243898
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: