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General NPI Number Information
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NPI Number | 1750550869
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Entity Type | Individual
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Provider Name | DEBRA SANDERCOCK
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Gender | Female
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Dates
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Enumeration Date | 02/22/2008
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Last Update Date | 02/22/2008
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Provider Practice Location Address
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Address Line | 428 E VANN RD
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City | GREENEVILLE
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State | TN
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Zip | 37743-7202
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Country | US
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Telephone | 423-278-2955
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Fax | 423-278-1976
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Provider Business Mailing Address
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Address Line | 428 E VANN RD
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City | GREENEVILLE
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State | TN
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Zip | 37743-7202
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Country | US
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Telephone | 423-278-2955
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Fax | 423-278-1976
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | ARN0000012945
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License Number State | TN
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