Healthcare Provider Details

I. General information

NPI: 1003164401
Provider Name (Legal Business Name): NAYOYINKA MARIA ANN SPENCER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2012
Last Update Date: 08/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 HART LN
NASHVILLE TN
37216-2007
US

IV. Provider business mailing address

717 HART LN
NASHVILLE TN
37216-2007
US

V. Phone/Fax

Practice location:
  • Phone: 615-568-0773
  • Fax: 615-771-0081
Mailing address:
  • Phone: 615-460-4290
  • Fax: 615-460-4292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number093305931
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: