Provider Demographics
NPI:1821390329
Name:MUNSON-MARKWAY, ELIZABETH CLARE (APN)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:CLARE
Last Name:MUNSON-MARKWAY
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:254 REN MAR DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PLEASANT VIEW
Mailing Address - State:TN
Mailing Address - Zip Code:37146-3722
Mailing Address - Country:US
Mailing Address - Phone:615-746-0203
Mailing Address - Fax:
Practice Address - Street 1:254 REN MAR DR
Practice Address - Street 2:SUITE 100
Practice Address - City:PLEASANT VIEW
Practice Address - State:TN
Practice Address - Zip Code:37146-3722
Practice Address - Country:US
Practice Address - Phone:615-746-0203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-03
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000015268363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I501917Medicare PIN