MEDICARE: CHRIS BENDEMIRE FNP-C

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	363LF0000X	Family Nurse Practitioner	31282	TN

General Provider Information

NPI Number	:	1598482648
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRIS BENDEMIRE FNP-C

Provider Business Mailing Address
First Line	:	141 DANA LN
Second Line	:
City	:	CHICKAMAUGA
State	:	GA
Zip	:	30707-1210
Country	:	US
Telephone Number	:	909-855-0174
Fax Number	:

Provider Business Practice Location Address
First Line	:	3917 GEORGETOWN RD NW
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37312-1806
Country	:	US
Telephone Number	:	423-813-3830
Fax Number	:

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

Provider Enumeration Date	:	10/19/2022
Last Update Date	:	12/20/2022

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