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General NPI Number Information
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NPI Number | 1699343525
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Entity Type | Organization
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Legal Business Name | MEN'S HEALTH OF MARYVILLE
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Dates
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Enumeration Date | 06/16/2021
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Last Update Date | 06/16/2021
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Provider Practice Location Address
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Address Line | 2010 W BROADWAY AVE
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City | MARYVILLE
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State | TN
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Zip | 37801-5404
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Country | US
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Telephone | 865-321-2934
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Fax |
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Provider Business Mailing Address
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Address Line | 2010 W BROADWAY AVE
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City | MARYVILLE
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State | TN
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Zip | 37801-5404
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER/OWNER
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Name | CYNTHIA WHISENANT
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Credential | FNP
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Telephone | 865-321-2934
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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