Provider Demographics
NPI:1093964447
Name:SYNAMON, MANDY LEE (REGISTERED NURSE)
Entity Type:Individual
Prefix:MRS
First Name:MANDY
Middle Name:LEE
Last Name:SYNAMON
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37814-4621
Mailing Address - Country:US
Mailing Address - Phone:423-586-1305
Mailing Address - Fax:
Practice Address - Street 1:331 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-4621
Practice Address - Country:US
Practice Address - Phone:423-586-6431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-10
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000132713163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse