Provider Demographics
NPI:1093022113
Name:SHORTER, DONNA LYNN (LVN)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:LYNN
Last Name:SHORTER
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6700 W 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-1701
Mailing Address - Country:US
Mailing Address - Phone:806-358-0251
Mailing Address - Fax:806-356-5590
Practice Address - Street 1:6700 W 9TH AVE
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1701
Practice Address - Country:US
Practice Address - Phone:806-358-0251
Practice Address - Fax:806-356-5590
Is Sole Proprietor?:No
Enumeration Date:2010-09-10
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX187862164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse