Individual
TENEKA RENEA BRODNAX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5728 STAGE RD STE 5, BARTLETT, TN 38134-4568
(901) 590-3832
Mailing address
5728 STAGE RD STE 5, BARTLETT, TN 38134-4568
(901) 590-3832
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
I000000028682
TN
372600000X
Adult Companion
Primary
I000000028682
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
L000000028682
STATE LICENSE
TN
Enumeration date
06/14/2021
Last updated
06/14/2021
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