Healthcare Provider Details

I. General information

NPI: 1104029313
Provider Name (Legal Business Name): MARY SUSAN RHODES RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 06/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 23RD AVE N
NASHVILLE TN
37203-1503
US

IV. Provider business mailing address

311 23RD AVE N RM 120
NASHVILLE TN
37203-1503
US

V. Phone/Fax

Practice location:
  • Phone: 615-340-2194
  • Fax: 615-340-2199
Mailing address:
  • Phone: 615-340-2194
  • Fax: 615-340-2199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number0000146044
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: