Provider Demographics
NPI:1376151415
Name:OGLE, ALISHA DANIELLE
Entity Type:Individual
Prefix:
First Name:ALISHA
Middle Name:DANIELLE
Last Name:OGLE
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 1:1837 MAGGIE ST
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37803-7700
Mailing Address - Country:US
Mailing Address - Phone:865-356-8400
Mailing Address - Fax:
Practice Address - Street 1:1837 MAGGIE ST
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37803-7700
Practice Address - Country:US
Practice Address - Phone:865-356-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-15
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000197821163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse