Provider Demographics
NPI:1790477420
Name:MILLENDER, SHARONDA DENOBIA (LPN)
Entity Type:Individual
Prefix:
First Name:SHARONDA
Middle Name:DENOBIA
Last Name:MILLENDER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7973 THUNDER BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT CAMPBELL
Mailing Address - State:KY
Mailing Address - Zip Code:42223-5531
Mailing Address - Country:US
Mailing Address - Phone:270-412-6349
Mailing Address - Fax:
Practice Address - Street 1:7973 THUNDER BLVD
Practice Address - Street 2:
Practice Address - City:FORT CAMPBELL
Practice Address - State:KY
Practice Address - Zip Code:42223-5531
Practice Address - Country:US
Practice Address - Phone:270-412-6349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN74408164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse