Provider Demographics
NPI:1710358767
Name:IYERE, EDNA
Entity Type:Individual
Prefix:
First Name:EDNA
Middle Name:
Last Name:IYERE
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 1:324 KOTTAS PL
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37217-3447
Mailing Address - Country:US
Mailing Address - Phone:615-649-8857
Mailing Address - Fax:615-647-7189
Practice Address - Street 1:2711 MURFREESBORO PIKE
Practice Address - Street 2:102
Practice Address - City:ANTIOCH
Practice Address - State:TN
Practice Address - Zip Code:37013-2000
Practice Address - Country:US
Practice Address - Phone:615-649-8857
Practice Address - Fax:615-647-7189
Is Sole Proprietor?:No
Enumeration Date:2015-10-16
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPN0000055312164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse