Provider Demographics
NPI:1083122642
Name:KAM, DANIELA
Entity Type:Individual
Prefix:MRS
First Name:DANIELA
Middle Name:
Last Name:KAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2615 MEDICAL CENTER PKWY STE 1560
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-3758
Mailing Address - Country:US
Mailing Address - Phone:615-505-1990
Mailing Address - Fax:
Practice Address - Street 1:2615 MEDICAL CENTER PKWY STE 1560
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-3758
Practice Address - Country:US
Practice Address - Phone:615-505-1990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-17
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN815174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty