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General NPI Number Information
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NPI Number | 1225339377
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Entity Type | Organization
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Legal Business Name | WILLOW MEDICAL, LLC
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Dates
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Enumeration Date | 11/05/2010
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Last Update Date | 05/02/2012
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Provider Practice Location Address
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Address Line | 193 RELCO DR
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City | MANCHESTER
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State | TN
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Zip | 37355-7386
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Country | US
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Telephone | 931-728-3097
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Fax |
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Provider Business Mailing Address
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Address Line | 193 RELCO DR
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City | MANCHESTER
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State | TN
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Zip | 37355-7386
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KATHERINE PROPST
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Credential |
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Telephone | 931-728-3097
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APN0000010747
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License Number State | TN
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