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General NPI Number Information
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NPI Number | 1275807554
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Entity Type | Individual
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Provider Name | JEANNIE LORAINE SOUTHERLAND LPN
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Gender | Female
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Dates
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Enumeration Date | 03/03/2012
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Last Update Date | 03/03/2012
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Provider Practice Location Address
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Address Line | 4850 E ANDREW JOHNSON HWY
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City | GREENEVILLE
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State | TN
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Zip | 37745-3098
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Country | US
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Telephone | 423-787-6641
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Fax |
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Provider Business Mailing Address
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Address Line | 3518 BLUE SPRINGS PKWY
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City | GREENEVILLE
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State | TN
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Zip | 37743-3058
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Country | US
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Telephone | 423-741-3267
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 70075
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License Number State | TN
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