Provider Demographics
NPI:1689720146
Name:BENNETT, TERESA DIANE (RN)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:DIANE
Last Name:BENNETT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:DIANE
Other - Last Name:SPARKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2235 LINN VIEW DR
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:TN
Mailing Address - Zip Code:37865-4445
Mailing Address - Country:US
Mailing Address - Phone:865-310-5665
Mailing Address - Fax:865-774-4379
Practice Address - Street 1:227 CEDAR ST
Practice Address - Street 2:
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37862-3838
Practice Address - Country:US
Practice Address - Phone:865-453-1032
Practice Address - Fax:865-453-7271
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000100595163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health