Healthcare Provider Details

I. General information

NPI: 1831432319
Provider Name (Legal Business Name): ABIEMWENSE QUEEN UWAIFO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ABIEMWENSE QUEEN UWAIFO ABIEMWENSE UWAIFO

II. Dates (important events)

Enumeration Date: 04/02/2013
Last Update Date: 08/14/2023
Certification Date: 03/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4805 COLUMBIA PIKE
THOMPSONS STATION TN
37179-5207
US

IV. Provider business mailing address

4805 COLUMBIA PIKE
THOMPSONS STATION TN
37179-5207
US

V. Phone/Fax

Practice location:
  • Phone: 615-791-0974
  • Fax:
Mailing address:
  • Phone: 615-791-0974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number17493
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: