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General NPI Number Information
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NPI Number | 1447731757
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Entity Type | Organization
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Legal Business Name | NISWANDER FAMILY MEDICINE INC
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Dates
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Enumeration Date | 08/24/2018
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Last Update Date | 08/21/2024
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Provider Practice Location Address
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Address Line | 88 W EDAN RD
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City | ETHRIDGE
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State | TN
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Zip | 38456-5137
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Country | US
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Telephone | 931-829-2056
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Fax | 931-829-2461
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Provider Business Mailing Address
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Address Line | 88 W EDAN RD
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City | ETHRIDGE
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State | TN
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Zip | 38456-5137
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Country | US
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Telephone | 931-829-2056
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Fax | 931-829-2461
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Authorized Official
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Title or Position | OWNER
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Name | RYAN MATTHEW NISWANDER
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Credential | NP
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Telephone | 931-244-7217
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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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