Healthcare Provider Details

I. General information

NPI: 1326521378
Provider Name (Legal Business Name): LIEGE FICHTEL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2018
Last Update Date: 09/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 E VINE ST
MURFREESBORO TN
37130-4248
US

IV. Provider business mailing address

5041 BRIARWOOD DR
NASHVILLE TN
37211-5103
US

V. Phone/Fax

Practice location:
  • Phone: 731-695-9881
  • Fax:
Mailing address:
  • Phone: 731-695-9881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN0000129090
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: