Provider Demographics
NPI:1043645088
Name:CHISHOLM, DONNA A (FNP)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:A
Last Name:CHISHOLM
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 GREEN CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:HENNING
Mailing Address - State:TN
Mailing Address - Zip Code:38041-5726
Mailing Address - Country:US
Mailing Address - Phone:731-738-5044
Mailing Address - Fax:731-738-0181
Practice Address - Street 1:480 GREEN CHAPEL RD
Practice Address - Street 2:
Practice Address - City:HENNING
Practice Address - State:TN
Practice Address - Zip Code:38041-5726
Practice Address - Country:US
Practice Address - Phone:731-738-5044
Practice Address - Fax:731-738-0181
Is Sole Proprietor?:No
Enumeration Date:2013-09-10
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000006200363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily