Provider Demographics
NPI:1558832816
Name:BRITTON, WENDY UNA
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:UNA
Last Name:BRITTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4014 FAIRVIEW DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37218-1924
Mailing Address - Country:US
Mailing Address - Phone:615-506-7190
Mailing Address - Fax:
Practice Address - Street 1:4014 FAIRVIEW DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37218-1924
Practice Address - Country:US
Practice Address - Phone:615-506-7190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN064629433172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN45-4543458Medicaid