MEDICARE: CLAIRE DESLENSON RENE SA-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	246ZC0007X	Surgical Assistant	22-425

General Provider Information

NPI Number	:	1639805864
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLAIRE DESLENSON RENE SA-C

Provider Business Mailing Address
First Line	:	4514 KINLOCK LN
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37921-1448
Country	:	US
Telephone Number	:	865-409-7780
Fax Number	:

Provider Business Practice Location Address
First Line	:	4514 KINLOCK LN
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37921-1448
Country	:	US
Telephone Number	:	865-409-7780
Fax Number	:

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

Provider Enumeration Date	:	07/29/2022
Last Update Date	:	07/29/2022

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Directions to “ CLAIRE DESLENSON RENE SA-C” Practice Location

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