Provider Demographics
NPI:1770186421
Name:DENOUDEN, DIPA
Entity Type:Individual
Prefix:
First Name:DIPA
Middle Name:
Last Name:DENOUDEN
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 1:1033 CROSSINGS BLVD
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37174-2776
Mailing Address - Country:US
Mailing Address - Phone:630-965-8932
Mailing Address - Fax:
Practice Address - Street 1:1033 CROSSINGS BLVD
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:TN
Practice Address - Zip Code:37174-2776
Practice Address - Country:US
Practice Address - Phone:931-489-6038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN44641183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist