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General NPI Number Information
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NPI Number | 1295774750
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Entity Type | Individual
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Provider Name | NINA LISETTE DE VILMORIN MD
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Gender | Female
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Dates
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Enumeration Date | 06/06/2006
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Last Update Date | 08/04/2025
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Provider Practice Location Address
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Address Line | 10415 WALLACE ALLEY ST
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City | KINGSPORT
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State | TN
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Zip | 37663-3936
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Country | US
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Telephone | 423-390-0451
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 603366
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City | CHARLOTTE
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State | NC
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Zip | 28260-3366
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Country | US
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Telephone | 240-566-1600
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Fax | 240-566-1605
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 2015-01341
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 148229
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License Number State | MT
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Taxonomy #3
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 74578
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License Number State | TN
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