Organization
GARNET HEALTH PROVIDER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LIESL R BULLEN APN (SOLE MEMBER/PROVIDER)
(901) 758-0280
Entity
Organization
Contact information
Practice address
4493 POTTERS CROSS DR, MEMPHIS, TN 38125-4421
(901) 336-8486
Mailing address
PO BOX 381531, GERMANTOWN, TN 38183-1531
(901) 417-1779
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
11962
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q020954
—
TN
Enumeration date
04/13/2016
Last updated
07/27/2016
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