MEDICARE: PATRICIA A DETZEL CNM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367A00000X	Advanced Practice Midwife	RN166939	GA
2	367A00000X	Advanced Practice Midwife	15211	TN

General Provider Information

NPI Number	:	1306802855
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA A DETZEL CNM

Provider Business Mailing Address
First Line	:	3841 GREEN HILLS VILLAGE DR STE 200
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37215-2691
Country	:	US
Telephone Number	:	770-597-3069
Fax Number	:	615-936-1106

Provider Business Practice Location Address
First Line	:	719 THOMPSON LN
Second Line	:	SUITE 27100
City	:	NASHVILLE
State	:	TN
Zip	:	37204-3609
Country	:	US
Telephone Number	:	615-343-5700
Fax Number	:	615-343-8806

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2006
Last Update Date	:	03/31/2022

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