Organization Name: | PINEWOOD MEDICAL LLC |
NPI Number: | 1073983920 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | SUSAN ORSBON (OWNER) |
Mailing Address: | 3499 Highway 70 W Dickson |
State: | TN US |
Postal Code: | 370554234 |
Phone Number: | 6155124099 |
Fax Number: | |
NPI Enumeration Date: | 10/05/2015 |
NPI Last Update Date: | 10/05/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 19587 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TN |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |