Provider Demographics
NPI:1861544306
Name:TENNER, DORIS M
Entity type:Individual
Prefix:MS
First Name:DORIS
Middle Name:M
Last Name:TENNER
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 1:2209 TILSEN AVE E
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55119-3201
Mailing Address - Country:US
Mailing Address - Phone:612-708-3222
Mailing Address - Fax:
Practice Address - Street 1:2200 UNIVERSITY AVE (STE 160)
Practice Address - Street 2:INTERIM HEALTH CARE
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114
Practice Address - Country:US
Practice Address - Phone:651-917-3634
Practice Address - Fax:651-917-3620
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide