Healthcare Provider Details

I. General information

NPI: 1487313425
Provider Name (Legal Business Name): MS. JEANETTE JEANETTE WIRZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2021
Last Update Date: 03/07/2024
Certification Date: 03/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8327 SAWYER BROWN RD
NASHVILLE TN
37221-2539
US

IV. Provider business mailing address

1180 BOB WHITE RD
KINGSTON SPRINGS TN
37082-5112
US

V. Phone/Fax

Practice location:
  • Phone: 615-400-2780
  • Fax:
Mailing address:
  • Phone: 615-400-2780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number210527
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: