Healthcare Provider Details

I. General information

NPI: 1982932059
Provider Name (Legal Business Name): BRONZEJUAN ELAINE WEBSTER BA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2009
Last Update Date: 11/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3810 WINCHESTER RD SOUTHEAST MHC
MEMPHIS TN
38118-6045
US

IV. Provider business mailing address

6565 CENTURY ARBOR PL W APT 107
MEMPHIS TN
38134-0135
US

V. Phone/Fax

Practice location:
  • Phone: 901-369-1420
  • Fax: 901-369-1433
Mailing address:
  • Phone: 901-484-4019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: