Healthcare Provider Details

I. General information

NPI: 1861062101
Provider Name (Legal Business Name): ELAINA LEE SCHNELLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2021
Last Update Date: 06/29/2021
Certification Date: 06/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 21ST AVE S # B
NASHVILLE TN
37212-3160
US

IV. Provider business mailing address

2128B SHARONDALE DR # B
NASHVILLE TN
37215-1231
US

V. Phone/Fax

Practice location:
  • Phone: 210-860-1459
  • Fax:
Mailing address:
  • Phone: 210-860-1459
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374700000X
TaxonomyTechnician
License NumberBACB389185
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: