Individual
NANCY CHEYENNE MADDOX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
3100 CRISP SPRINGS RD, MCMINNVILLE, TN 37110-5238
(931) 939-5045
Mailing address
3100 CRISP SPRINGS RD, MCMINNVILLE, TN 37110-5238
(931) 939-5045
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
93795
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
116111934
DRIVER LICENSE
TN
Enumeration date
03/05/2021
Last updated
03/05/2021
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