Healthcare Provider Details

I. General information

NPI: 1003360249
Provider Name (Legal Business Name): CONSTANCE DENISON 143768
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2016
Last Update Date: 08/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 OAK DR
UNICOI TN
37692-6407
US

IV. Provider business mailing address

127 OAK DR
UNICOI TN
37692-6407
US

V. Phone/Fax

Practice location:
  • Phone: 423-735-7935
  • Fax:
Mailing address:
  • Phone: 423-735-7935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number143768
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: