Healthcare Provider Details

I. General information

NPI: 1811100019
Provider Name (Legal Business Name): NICOLE A. LAMAINA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

800 S BROWN ST
SPRINGFIELD TN
37172-2920
US

IV. Provider business mailing address

800 S BROWN ST
SPRINGFIELD TN
37172-2920
US

V. Phone/Fax

Practice location:
  • Phone: 615-384-0208
  • Fax: 615-384-0245
Mailing address:
  • Phone: 615-384-0208
  • Fax: 615-384-0245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number158491
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: