Provider Demographics
NPI:1821775545
Name:BENTON, WENDY R
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:R
Last Name:BENTON
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 1:9986 HOUSTON BIRCH DR
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-7137
Mailing Address - Country:US
Mailing Address - Phone:901-502-9254
Mailing Address - Fax:
Practice Address - Street 1:9986 HOUSTON BIRCH DR
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-7137
Practice Address - Country:US
Practice Address - Phone:901-502-9254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-04
Last Update Date:2023-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide