Provider Demographics
NPI:1720604549
Name:TRULY, IDA PATRICE
Entity Type:Individual
Prefix:
First Name:IDA
Middle Name:PATRICE
Last Name:TRULY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:IDA
Other - Middle Name:PATRICE
Other - Last Name:BRISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:717 HART LN
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37216-2007
Mailing Address - Country:US
Mailing Address - Phone:615-460-4290
Mailing Address - Fax:
Practice Address - Street 1:717 HART LN
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37216-2007
Practice Address - Country:US
Practice Address - Phone:615-460-4290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-17
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No374700000XNursing Service Related ProvidersTechnician