MEDICARE: MRS. JOSEPHINE SWANN NODELL RN CPNC

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	363LP0200X	Pediatric Nurse Practitioner	APN0000005403	TN

General Provider Information

NPI Number	:	1518060136
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JOSEPHINE SWANN NODELL RN CPNC

Provider Business Mailing Address
First Line	:	4529 ASHEVILLE HWY
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37914-3607
Country	:	US
Telephone Number	:	865-522-8114
Fax Number	:	865-522-1161

Provider Business Practice Location Address
First Line	:	4529 ASHEVILLE HWY
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37914-3607
Country	:	US
Telephone Number	:	865-522-8114
Fax Number	:	865-522-1161

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

Provider Enumeration Date	:	09/07/2006
Last Update Date	:	07/08/2007

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