=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073944351
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DEIDRE EARLENE LANIER M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/11/2013
-----------------------------------------------------
Last Update Date | 12/11/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 404 DR. D.B. TODD BLVD JR.
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37203
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-327-3801
-----------------------------------------------------
Fax | 615-329-0694
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 404 DR. D. B. TODD BLVD JR. BLVD
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37203
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-327-3801
-----------------------------------------------------
Fax | 615-329-0694
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | MD16121
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------