=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750687422
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STORMIEE DANIELLE ELDRED FNP- BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/28/2011
-----------------------------------------------------
Last Update Date | 01/28/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 133 HOSPITAL DR SUITE 200
-----------------------------------------------------
City | CARTHAGE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37030-4004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-735-3450
-----------------------------------------------------
Fax | 615-735-3560
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 133 HOSPITAL DR SUITE 200
-----------------------------------------------------
City | CARTHAGE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37030-4004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-735-3450
-----------------------------------------------------
Fax | 615-735-3560
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 15513
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------