Provider Demographics
NPI:1528274115
Name:DECOUTEAU, CYNTHIA LEE (LPN)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:LEE
Last Name:DECOUTEAU
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5850 LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:TALLASSEE
Mailing Address - State:TN
Mailing Address - Zip Code:37878-2412
Mailing Address - Country:US
Mailing Address - Phone:865-215-5320
Mailing Address - Fax:
Practice Address - Street 1:104 DAMRON AVENUE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37917-6413
Practice Address - Country:US
Practice Address - Phone:865-215-5320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNEMT0000010966146N00000X
TNLPN0000042368164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
Not Answered164W00000XNursing Service ProvidersLicensed Practical Nurse