Individual
DESTINI BLANCHE GONYON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
2891 KNOB CREEK RD, COLUMBIA, TN 38401-1437
(931) 797-8744
Mailing address
2891 KNOB CREEK RD, COLUMBIA, TN 38401-1437
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
76069
TN
Other
Enumeration date
08/27/2013
Last updated
08/27/2013
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