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Individual

MRS. TONJA MYSHAWNE FOGG

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LPN

Contact information

Practice address
1310 24TH AVE S, NASHVILLE, TN 37212-2637
(615) 327-4751
Mailing address
3113 GREGGWOOD DR, NASHVILLE, TN 37207-2707
(615) 876-9874

Taxonomy

Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
LPN0000066910
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0000066910
LPN
TN
Enumeration date
01/12/2007
Last updated
07/08/2007
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