Provider Demographics
NPI:1285415562
Name:DENMARK, TERREL RAINES
Entity type:Individual
Prefix:
First Name:TERREL
Middle Name:RAINES
Last Name:DENMARK
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 1:38 HARVEY CIR
Mailing Address - Street 2:
Mailing Address - City:ELLAVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31806-8821
Mailing Address - Country:US
Mailing Address - Phone:229-591-4735
Mailing Address - Fax:
Practice Address - Street 1:38 HARVEY CIR
Practice Address - Street 2:
Practice Address - City:ELLAVILLE
Practice Address - State:GA
Practice Address - Zip Code:31806-8821
Practice Address - Country:US
Practice Address - Phone:229-591-4735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN079442164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse