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General NPI Number Information
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NPI Number | 1851759864
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Entity Type | Organization
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Legal Business Name | CAPE SIERRA CLINIC LLC
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Dates
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Enumeration Date | 02/04/2016
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Last Update Date | 02/14/2020
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Provider Practice Location Address
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Address Line | 5630 NOLENSVILLE PIKE
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City | NASHVILLE
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State | TN
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Zip | 37211-6422
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Country | US
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Telephone | 615-396-8997
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Fax | 615-809-2062
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Provider Business Mailing Address
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Address Line | 6688 NOLENSVILLE RD STE 108-41
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City | BRENTWOOD
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State | TN
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Zip | 37027-8833
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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 | MEMBER
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Name | DR. JACQUELINE A BANGURA
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Credential | DNP
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Telephone | 615-396-8997
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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