Provider Demographics
NPI:1679130652
Name:WILLER, DENISE LYNNE (RN)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:LYNNE
Last Name:WILLER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:629 GALLAHER RD
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:TN
Mailing Address - Zip Code:37763-4215
Mailing Address - Country:US
Mailing Address - Phone:865-376-3416
Mailing Address - Fax:
Practice Address - Street 1:629 GALLAHER RD
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:TN
Practice Address - Zip Code:37763-4215
Practice Address - Country:US
Practice Address - Phone:865-376-3416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-24
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN112216163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNRN112216OtherRN LICENSE