MEDICARE: SUSANA R ENCISO CNIM

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	246ZE0600X	Electroneurodiagnostic Specialist/Technologist	2071	TX

General Provider Information

NPI Number	:	1518300250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSANA R ENCISO CNIM

Provider Business Mailing Address
First Line	:	5035 JACKSBORO PIKE
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37918-1845
Country	:	US
Telephone Number	:	915-373-7868
Fax Number	:

Provider Business Practice Location Address
First Line	:	5035 JACKSBORO PIKE
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37918-1845
Country	:	US
Telephone Number	:	915-373-7868
Fax Number	:

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

Provider Enumeration Date	:	04/11/2013
Last Update Date	:	02/10/2026

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Directions to “ SUSANA R ENCISO CNIM” Practice Location

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