Healthcare Provider Details

I. General information

NPI: 1366759854
Provider Name (Legal Business Name): TENA LOU WASHBURN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2010
Last Update Date: 09/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2379 BUFFALO RD
LAWRENCEBURG TN
38464-4810
US

IV. Provider business mailing address

973 TURNPIKE RD
SUMMERTOWN TN
38483-7239
US

V. Phone/Fax

Practice location:
  • Phone: 931-762-9406
  • Fax: 931-766-1592
Mailing address:
  • Phone: 931-762-9406
  • Fax: 931-766-1592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0000064237
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: