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General NPI Number Information
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NPI Number | 1285066407
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Entity Type | Organization
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Legal Business Name | GREENBRIER MEDICAL
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Dates
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Enumeration Date | 07/30/2013
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Last Update Date | 07/30/2013
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Provider Practice Location Address
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Address Line | 1110 VILLAGE DR
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City | SEVIERVILLE
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State | TN
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Zip | 37862-5028
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Country | US
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Telephone | 865-453-0792
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Fax | 865-429-5006
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Provider Business Mailing Address
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Address Line | 1110 VILLAGE DR
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City | SEVIERVILLE
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State | TN
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Zip | 37862-5028
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Country | US
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Telephone | 865-453-0792
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Fax | 865-429-5006
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Authorized Official
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Title or Position | FAMILY NURSE PRACTITIONER
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Name | MELISSA ANN LARGE
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Credential | MSN, FNP
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Telephone | 865-453-0792
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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 | 13614
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License Number State | TN
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