Provider Demographics
NPI:1902385198
Name:MALDONADO, DENISIA BERNADETTE (CERTIFIED SURGICAL A)
Entity Type:Individual
Prefix:MS
First Name:DENISIA
Middle Name:BERNADETTE
Last Name:MALDONADO
Suffix:
Gender:F
Credentials:CERTIFIED SURGICAL A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 MEDICAL CENTER BLVD.
Mailing Address - Street 2:SUITE #100
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37334
Mailing Address - Country:US
Mailing Address - Phone:931-433-1102
Mailing Address - Fax:931-433-0522
Practice Address - Street 1:108 MEDICAL CENTER BLVD.
Practice Address - Street 2:SUITE #100
Practice Address - City:FAYETTEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37334
Practice Address - Country:US
Practice Address - Phone:931-433-1102
Practice Address - Fax:931-433-0522
Is Sole Proprietor?:No
Enumeration Date:2018-08-09
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant