Provider Demographics
NPI:1760685259
Name:FANNING, MILDRED (LPN)
Entity Type:Individual
Prefix:
First Name:MILDRED
Middle Name:
Last Name:FANNING
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:MIKKI
Other - Middle Name:
Other - Last Name:FANNING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:311 23RD AVE N
Mailing Address - Street 2:SUITE 120
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1503
Mailing Address - Country:US
Mailing Address - Phone:615-340-5607
Mailing Address - Fax:615-340-2199
Practice Address - Street 1:311 23RD AVE N
Practice Address - Street 2:SUITE 120
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1503
Practice Address - Country:US
Practice Address - Phone:615-340-5607
Practice Address - Fax:615-340-2199
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPN0000023570164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse