Brenda Marie Diaz
Individual provider Active NPI Licensed Practical Nurse · Evensville, TN
NPI 1003485632 · NPPES record last updated Jun 18, 2021
Key facts
- NPI
- 1003485632
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Licensed Practical Nurse 164W00000X
- License
- LPN0000094744 (TN)
- Practice address
- 334 Eagle LN
Evensville, TN 37332 - Phone
- (423) 775-7819
- Fax
- (423) 775-8078
- NPI assigned
- Jun 18, 2021
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LPN0000094744 | TN | MD | Licensed Practical Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | LPN0000094744 | TN | Yes |
Addresses
Primary practice location
334 Eagle LN
Evensville, TN 37332
Mailing address
334 Eagle LN
Evensville, TN 37332
Phone (423) 775-7819
Other providers in Evensville, TN
- Carsi Beaty
- Amanda Curtis
- Sonya C Franklin
- James Arthur Knudtson
- Evelyn Michelle Manley
- Kimberly Diane Nesbitt
- Ocoee Regional Health Corporation
All providers in Evensville, TN · Licensed Practical Nurse in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 18, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.