MEDICARE: MRS. CONSTANCE DENISON 143768

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374U00000X	Home Health Aide	143768	TN

General Provider Information

NPI Number	:	1003360249
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CONSTANCE DENISON 143768

Provider Business Mailing Address
First Line	:	127 OAK DR
Second Line	:
City	:	UNICOI
State	:	TN
Zip	:	37692-6407
Country	:	US
Telephone Number	:	423-735-7935
Fax Number	:

Provider Business Practice Location Address
First Line	:	127 OAK DR
Second Line	:
City	:	UNICOI
State	:	TN
Zip	:	37692-6407
Country	:	US
Telephone Number	:	423-735-7935
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2016
Last Update Date	:	08/04/2016

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