Individual
AVA ROSE DETTORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
4104 DAYTON BLVD, RED BANK, TN 37415-7155
(423) 499-7710
Mailing address
4104 DAYTON BLVD, RED BANK, TN 37415-7155
(423) 499-7710
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
6179
TN
Other
Enumeration date
09/16/2024
Last updated
09/16/2024
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