Individual
MISTY NIROCA PAUL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2702 ROBERTS RIDGE RD, MANCHESTER, TN 37355-4246
(931) 312-0369
Mailing address
800 PARKS ST, MANCHESTER, TN 37355-2482
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
63334
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00503772
DEPARTMENT OF HEALTH
TN
Enumeration date
10/09/2017
Last updated
10/09/2017
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