Provider Demographics
NPI:1962547810
Name:CHILDRESS, ELANE RUTH (RN)
Entity type:Individual
Prefix:MS
First Name:ELANE
Middle Name:RUTH
Last Name:CHILDRESS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6501 TELECOM DR
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:TN
Mailing Address - Zip Code:38358-3448
Mailing Address - Country:US
Mailing Address - Phone:731-686-9240
Mailing Address - Fax:731-686-0962
Practice Address - Street 1:6501 TELECOM DR
Practice Address - Street 2:
Practice Address - City:MILAN
Practice Address - State:TN
Practice Address - Zip Code:38358-3448
Practice Address - Country:US
Practice Address - Phone:731-686-9240
Practice Address - Fax:731-686-0962
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000034874163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health