Provider Demographics
NPI:1699448027
Name:VENUK, JENNIFER WILLENE (NP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:WILLENE
Last Name:VENUK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:641 PATTERSON RD
Mailing Address - Street 2:
Mailing Address - City:WALLAND
Mailing Address - State:TN
Mailing Address - Zip Code:37886-2030
Mailing Address - Country:US
Mailing Address - Phone:865-679-9389
Mailing Address - Fax:
Practice Address - Street 1:220 BMH CANCER CTR
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-5922
Practice Address - Country:US
Practice Address - Phone:865-977-1065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-30
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN29337363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ068423Medicaid