Healthcare Provider Details

I. General information

NPI: 1972298503
Provider Name (Legal Business Name): TWELVESTONE INFUSION SUPPORT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2023
Last Update Date: 04/10/2023
Certification Date: 04/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

352 W NORTHFIELD BLVD
MURFREESBORO TN
37129-1539
US

IV. Provider business mailing address

352 W NORTHFIELD BLVD
MURFREESBORO TN
37129-1539
US

V. Phone/Fax

Practice location:
  • Phone: 615-278-3278
  • Fax:
Mailing address:
  • Phone: 615-278-3278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: TARA HARRELSON
Title or Position: DIRECTOR
Credential:
Phone: 615-278-3278