Provider Demographics
NPI:1396036034
Name:BENDER, TAMMY LYNN (PCT)
Entity type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:LYNN
Last Name:BENDER
Suffix:
Gender:F
Credentials:PCT
Other - Prefix:
Other - First Name:HOME
Other - Middle Name:NURSING
Other - Last Name:SOLUTIONS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:123 MOSS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CEDAR GROVE
Mailing Address - State:TN
Mailing Address - Zip Code:38321-7459
Mailing Address - Country:US
Mailing Address - Phone:731-414-8735
Mailing Address - Fax:
Practice Address - Street 1:123 MOSS CREEK RD
Practice Address - Street 2:
Practice Address - City:CEDAR GROVE
Practice Address - State:TN
Practice Address - Zip Code:38321-7459
Practice Address - Country:US
Practice Address - Phone:731-414-8735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-28
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO390200000X
TN376J00000X, 376K00000X, 374U00000X, 372600000X, 372500000X
372600000X, 372500000X, 374U00000X, 376K00000X, 3747P1801X, 376J00000X, 373H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No376J00000XNursing Service Related ProvidersHomemaker
No376K00000XNursing Service Related ProvidersNurse's Aide
No372600000XNursing Service Related ProvidersAdult Companion
No372500000XNursing Service Related ProvidersChore Provider
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist