Crossroads Clinic PLLC
Nurse Practitioner, Primary Care in Ooltewah, TN. Organization (NPI-2).
NPI number1043662687
StatusActive
Last updated in NPPESJul 7, 2016
Details
- NPI
- 1043662687
- Entity type
- Organization (NPI-2)
- Legal business name
- Crossroads Clinic PLLC
- Organization subpart
- No
- Enumeration date
- Jul 7, 2016
- Last updated
- Jul 7, 2016
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LP2300X | Nurse Practitioner, Primary Care | – | – | Yes |
Practice location
1667 Ooltewah Ringgold RdSuite 111
Ooltewah, TN 37363-9830
Phone 423-825-4881 · Fax 423-825-4882
Mailing address
1667 Ooltewah Ringgold RdSuite 111
Ooltewah, TN 37363-9830
Phone 423-825-4881 · Fax 423-825-4882
Authorized official
Susan Vergot
Owner
4239020681
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