Individual
JANUARY LANIECE BOMAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
1754 TEXAS AVE, KNOXVILLE, TN 37921-2513
(865) 934-6165
(865) 342-0165
Mailing address
1923 SULPHUR SPRINGS RD, MORRISTOWN, TN 37813-5654
(423) 317-9344
(423) 714-2355
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
96745
TN
Other
Enumeration date
02/22/2022
Last updated
02/22/2022
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