Provider Demographics
NPI:1073096293
Name:DONALD, DARRELL WAYNE
Entity Type:Individual
Prefix:
First Name:DARRELL
Middle Name:WAYNE
Last Name:DONALD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 HELM LN
Mailing Address - Street 2:
Mailing Address - City:SULPHUR SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:75482-3434
Mailing Address - Country:US
Mailing Address - Phone:903-335-4350
Mailing Address - Fax:
Practice Address - Street 1:217 HELM LN
Practice Address - Street 2:
Practice Address - City:SULPHUR SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:75482-3434
Practice Address - Country:US
Practice Address - Phone:903-335-4350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-13
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX898802163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse