Individual
ELEANOR LACSA SAN PEDRO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
7691 POPLAR AVE, GERMANTOWN, TN 38138-3904
(901) 516-6386
Mailing address
8725 STONY GLEN DR, BARTLETT, TN 38133-2150
(662) 402-0779
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
0000294113
TN
163WC0200X
Critical Care Medicine Registered Nurse
Primary
0000294113
TN
163WC0200X
Critical Care Medicine Registered Nurse
894837
MS
163WG0000X
General Practice Registered Nurse
0000294113
TN
163WM0705X
Medical-Surgical Registered Nurse
0000294113
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000249113
REGISTERED NURSE
TN
01
—
894837
REGISTERED NURSE
MS
Enumeration date
01/07/2021
Last updated
01/07/2021
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