Healthcare Provider Details

I. General information

NPI: 1083538425
Provider Name (Legal Business Name): SRIJANA DANGAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 OLD CAVE SPRINGS RD
TAZEWELL TN
37879-3943
US

IV. Provider business mailing address

505 OLD CAVE SPRINGS RD
TAZEWELL TN
37879-3943
US

V. Phone/Fax

Practice location:
  • Phone: 619-874-0578
  • Fax:
Mailing address:
  • Phone: 619-874-0578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number42712
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: