| Evergreen Nephrology Of The Midwest, Pllc | |
|
210 Athens Way Ste 200 Nashville TN 37228-1308 | |
| (615) 270-3505 | |
| Not Available |
| Full Name | Evergreen Nephrology Of The Midwest, Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 210 Athens Way Ste 200, Nashville, Tennessee |
| Authorized Official Name and Position | Stanley Crittenden (OWNER) |
| Authorized Official Contact | 3134181065 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Evergreen Nephrology Of The Midwest, Pllc 210 Athens Way Ste 200 Nashville TN 37228-1308 Ph: () - | Evergreen Nephrology Of The Midwest, Pllc 210 Athens Way Ste 200 Nashville TN 37228-1308 Ph: (615) 270-3505 |
| NPI Number | 1801597869 |
|---|---|
| Provider Enumeration Date | 03/15/2023 |
| Last Update Date | 03/15/2023 |
| Certification Date | 03/15/2023 |
| Medicare PECOS PAC ID | 3476914961 |
|---|---|
| Medicare Enrollment ID | O20230731003747 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801597869 | NPI | - | NPPES |
| Provider Name | Jami M Wallace |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144606195 PECOS PAC ID: 6002108693 Enrollment ID: I20160629002488 |
| Provider Name | Miranda Perrero |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1427545847 PECOS PAC ID: 7012323454 Enrollment ID: I20210309001865 |
| Provider Name | Gayle Fengel |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1639405160 PECOS PAC ID: 5294106803 Enrollment ID: I20230118002025 |
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