Basic Information
| Provider Information | |||||||||
| NPI: | 1184259350 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BYDLINSKI | ||||||||
| FirstName: | NICOLE (BELLA) | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6026 PARSONS POND DR | ||||||||
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| City: | OOLTEWAH | ||||||||
| State: | TN | ||||||||
| PostalCode: | 373638868 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9018343163 | ||||||||
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| Practice Location | |||||||||
| Address1: | 750 OLD HICKORY BLVD STE 150 | ||||||||
| Address2: | |||||||||
| City: | BRENTWOOD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370275387 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4843518459 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2020 | ||||||||
| LastUpdateDate: | 03/09/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 246Z00000X | 4467 | Y | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Other |
No ID Information.