Healthcare Provider Details

I. General information

NPI: 1154532018
Provider Name (Legal Business Name): WENDY WIMBROW LAFOREST PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10626 CHAPMAN HWY
SEYMOUR TN
37865-4703
US

IV. Provider business mailing address

10626 CHAPMAN HWY
SEYMOUR TN
37865-4703
US

V. Phone/Fax

Practice location:
  • Phone: 865-577-5231
  • Fax: 865-577-1539
Mailing address:
  • Phone: 865-577-5231
  • Fax: 865-577-1539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPN0000012720
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: