Provider Demographics
NPI:1417095209
Name:PETREE, ELANOR
Entity Type:Individual
Prefix:
First Name:ELANOR
Middle Name:
Last Name:PETREE
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 1:660 EMORY RD
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:TN
Mailing Address - Zip Code:37709-2425
Mailing Address - Country:US
Mailing Address - Phone:865-932-1456
Mailing Address - Fax:
Practice Address - Street 1:405 DANTE RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37918-9719
Practice Address - Country:US
Practice Address - Phone:865-215-5500
Practice Address - Fax:865-215-5505
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPN0000046945164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse