Provider Demographics
NPI:1376385229
Name:BOTTS, MARINDA GAYE (LPN)
Entity type:Individual
Prefix:
First Name:MARINDA
Middle Name:GAYE
Last Name:BOTTS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 W ROBBINS RD
Mailing Address - Street 2:
Mailing Address - City:ROBBINS
Mailing Address - State:TN
Mailing Address - Zip Code:37852-3524
Mailing Address - Country:US
Mailing Address - Phone:423-215-0565
Mailing Address - Fax:
Practice Address - Street 1:575 W ROBBINS RD
Practice Address - Street 2:
Practice Address - City:ROBBINS
Practice Address - State:TN
Practice Address - Zip Code:37852-3524
Practice Address - Country:US
Practice Address - Phone:423-215-0565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-11
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN50901164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse