Provider Demographics
NPI:1689861767
Name:ENNIS, NEVA GAIL (RN)
Entity Type:Individual
Prefix:MRS
First Name:NEVA
Middle Name:GAIL
Last Name:ENNIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:592 SUMMERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37663-3100
Mailing Address - Country:US
Mailing Address - Phone:423-239-7681
Mailing Address - Fax:
Practice Address - Street 1:592 SUMMERVILLE RD
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37663-3100
Practice Address - Country:US
Practice Address - Phone:423-239-7681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-02
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000047239163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse