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Individual

DIANE BAKKE TENNANT

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PT

Contact information

Practice address
60 CENTRAL AVE, CORTLAND, NY 13045-2795
(607) 756-3401
Mailing address
3739 LYNCOURT DRIVE, CORTLAND, NY 13045
(607) 756-2479

Taxonomy

Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
62002602
NY

Other

Enumeration date
05/28/2010
Last updated
05/28/2010
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