Provider Demographics
NPI:1689891525
Name:WILLS, THERESA (RNC)
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:
Last Name:WILLS
Suffix:
Gender:F
Credentials:RNC
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:
Other - Last Name:FORREST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1342 WHITE OAK RD
Mailing Address - Street 2:
Mailing Address - City:MC EWEN
Mailing Address - State:TN
Mailing Address - Zip Code:37101-5303
Mailing Address - Country:US
Mailing Address - Phone:931-582-7749
Mailing Address - Fax:
Practice Address - Street 1:275 CUMBERLAND BND
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37228-1803
Practice Address - Country:US
Practice Address - Phone:615-446-3061
Practice Address - Fax:615-446-9567
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000122788163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health