Healthcare Provider Details

I. General information

NPI: 1689891525
Provider Name (Legal Business Name): THERESA WILLS RNC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: THERESA FORREST RN

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 CUMBERLAND BND
NASHVILLE TN
37228-1803
US

IV. Provider business mailing address

1342 WHITE OAK RD
MC EWEN TN
37101-5303
US

V. Phone/Fax

Practice location:
  • Phone: 615-446-3061
  • Fax: 615-446-9567
Mailing address:
  • Phone: 931-582-7749
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN0000122788
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: