Provider Demographics
NPI:1578761565
Name:FLUELLEN, MILLENESE RUDAIRE
Entity Type:Individual
Prefix:
First Name:MILLENESE
Middle Name:RUDAIRE
Last Name:FLUELLEN
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:VANDERBILT ORTHOPEDIC INSTITUTE
Mailing Address - Street 2:1215 21ST AVE SOUT SUITE 3312 3200 MEDICAL CENTER EAST
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37232-0001
Mailing Address - Country:US
Mailing Address - Phone:615-343-7491
Mailing Address - Fax:
Practice Address - Street 1:VANDERBILT ORTHOPEDIC INSTITUTE
Practice Address - Street 2:1215 21ST AVE SOUT SUITE 3312 3200 MEDICAL CENTER EAST
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37232-0001
Practice Address - Country:US
Practice Address - Phone:615-343-7491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000577225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant