Organization
PORTLAND MEDICAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LISA MARIE NAZARENUS APN (APN)
(615) 804-9470
Entity
Organization
Contact information
Practice address
307 S BROADWAY ST, PORTLAND, TN 37148-1413
(615) 325-6755
Mailing address
106 PIRES LN, PORTLAND, TN 37148-4900
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
—
—
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Enumeration date
11/28/2021
Last updated
11/28/2021
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