Provider Demographics
NPI:1497363642
Name:JEZIOR, NATALIE CHRISTINE
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:CHRISTINE
Last Name:JEZIOR
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 1:156 SILVER ST APT A6
Mailing Address - Street 2:
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388-2899
Mailing Address - Country:US
Mailing Address - Phone:219-776-9982
Mailing Address - Fax:
Practice Address - Street 1:700 N JACKSON ST
Practice Address - Street 2:
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-3544
Practice Address - Country:US
Practice Address - Phone:931-455-6778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-14
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN44315183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist