=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972298503
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TWELVESTONE INFUSION SUPPORT, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/10/2023
-----------------------------------------------------
Last Update Date | 04/10/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 352 W NORTHFIELD BLVD
-----------------------------------------------------
City | MURFREESBORO
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37129-1539
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-278-3278
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 352 W NORTHFIELD BLVD
-----------------------------------------------------
City | MURFREESBORO
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37129-1539
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-278-3278
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | TARA HARRELSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 615-278-3278
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WI0500X
-----------------------------------------------------
Taxonomy Name | Infusion Therapy Registered Nurse
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------