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General NPI Number Information
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NPI Number | 1386968113
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Entity Type | Organization
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Legal Business Name | EAST TENNESSEE FAMILY CARE LLC
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Dates
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Enumeration Date | 03/23/2010
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Last Update Date | 03/23/2010
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Provider Practice Location Address
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Address Line | 3010 BRISTOL HWY
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City | JOHNSON CITY
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State | TN
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Zip | 37601-1512
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Country | US
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Telephone | 423-282-4170
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Fax | 423-282-4903
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Provider Business Mailing Address
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Address Line | 3010 BRISTOL HWY
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City | JOHNSON CITY
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State | TN
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Zip | 37601-1512
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Country | US
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Telephone | 423-282-4170
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Fax | 423-282-4903
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Authorized Official
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Title or Position | PRESIDENT
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Name | WENDY D SWINEY
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Credential | ANP
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Telephone | 423-282-4170
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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 |
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License Number State |
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