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General NPI Number Information
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NPI Number | 1336561943
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Entity Type | Organization
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Legal Business Name | RENOVATION HEALTH AND WELLNESS
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Dates
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Enumeration Date | 01/16/2014
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Last Update Date | 01/16/2014
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Provider Practice Location Address
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Address Line | 2707 JACKSBORO PIKE SUITE 1A
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City | JACKSBORO
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State | TN
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Zip | 37757-2752
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Country | US
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Telephone | 423-907-8186
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Fax | 423-907-8187
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Provider Business Mailing Address
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Address Line | 2707 JACKSBORO PIKE SUITE 1A
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City | JACKSBORO
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State | TN
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Zip | 37757-2752
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Country | US
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Telephone | 423-907-8186
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Fax | 423-907-8187
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Authorized Official
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Title or Position | CHIEF OFFICER/OWNER
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Name | MRS. PATRICIA EBERHARTER
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Credential | FNP-BC
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Telephone | 423-907-8186
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364SF0001X
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Taxonomy Name | Family Health Clinical Nurse Specialist
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License Number | 14789
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License Number State | TN
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