Individual provider · NPI-1

La Wanna Wallen Brock, F.N.P., A.P.N.

Nurse Practitioner, Family · Tazewell, TN

NPI number1407932387
StatusActive
Last updated in NPPESJul 8, 2007

Details

NPI
1407932387
Entity type
Individual (NPI-1)
Name
La Wanna Wallen Brock
Credential
F.N.P., A.P.N.
Sex
Female
Sole proprietor
No
Enumeration date
Oct 31, 2006
Last updated
Jul 8, 2007

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
363LF0000X Nurse Practitioner, FamilyAPN6601TNYes

Practice location

1442 North Broad Street
Suite 7
Tazewell, TN 37879

Phone 423-626-6145 · Fax 423-526-2804

Mailing address

1037 Old Jacksboro Rd
Cumberland Gap, TN 37724-4444

Phone 423-626-6145 · Fax 423-526-2804

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