Provider Demographics
NPI:1306075684
Name:SAENPHANSIRI, XAIYAVONG (APN, FNP)
Entity type:Individual
Prefix:MR
First Name:XAIYAVONG
Middle Name:
Last Name:SAENPHANSIRI
Suffix:
Gender:M
Credentials:APN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 ROBERT ROSE DRIVE,
Mailing Address - Street 2:SUITE F
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129
Mailing Address - Country:US
Mailing Address - Phone:615-849-4081
Mailing Address - Fax:615-895-0856
Practice Address - Street 1:315 ROBERT ROSE DRIVE,
Practice Address - Street 2:SUITE F
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129
Practice Address - Country:US
Practice Address - Phone:615-849-4081
Practice Address - Fax:615-895-0856
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-08
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000014210363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily