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General NPI Number Information
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NPI Number | 1912256769
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Entity Type | Organization
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Legal Business Name | SOLACE THERAPEUTICS, INC
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Dates
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Enumeration Date | 09/06/2012
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Last Update Date | 09/06/2012
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Provider Practice Location Address
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Address Line | 11606 CHAPMAN HWY STE 3
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City | SEYMOUR
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State | TN
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Zip | 37865-5270
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Country | US
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Telephone | 865-773-0285
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Fax | 865-773-0335
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Provider Business Mailing Address
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Address Line | 11606 CHAPMAN HWY STE 3
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City | SEYMOUR
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State | TN
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Zip | 37865-5270
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Country | US
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Telephone | 865-773-0285
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Fax | 865-773-0335
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Authorized Official
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Title or Position | OWNER
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Name | MRS. LAURA ANN MOORE
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Credential | NP
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Telephone | 865-773-0285
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 14396
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License Number State | TN
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