Healthcare Provider Details

I. General information

NPI: 1497330799
Provider Name (Legal Business Name): CHANDLER WASHBURN PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2021
Last Update Date: 06/17/2024
Certification Date: 02/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

238 CENTRE ST. SUITE 100
PLEASANT VIEW TN
37146
US

IV. Provider business mailing address

238 CENTRE ST. SUITE 100
PLEASANT VIEW TN
37146
US

V. Phone/Fax

Practice location:
  • Phone: 615-746-4040
  • Fax: 615-746-4044
Mailing address:
  • Phone: 615-746-4040
  • Fax: 615-746-4044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberAPN28362
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: