Healthcare Provider Details

I. General information

NPI: 1942300892
Provider Name (Legal Business Name): BIANCA JUSELLE SWEETEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 07/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1407 UNION AVE SUITE 305
MEMPHIS TN
38104-3627
US

IV. Provider business mailing address

1407 UNION AVE SUITE 305
MEMPHIS TN
38104-3627
US

V. Phone/Fax

Practice location:
  • Phone: 901-844-1459
  • Fax: 901-274-3475
Mailing address:
  • Phone: 901-844-1459
  • Fax: 901-274-3475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number34353
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: