Provider Demographics
NPI:1104396050
Name:STRAUT, DONALD CORNELIUS JR (LPN)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:CORNELIUS
Last Name:STRAUT
Suffix:JR
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:378 OLD BRIMSTONE RD
Mailing Address - Street 2:
Mailing Address - City:HELENWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37755-5432
Mailing Address - Country:US
Mailing Address - Phone:423-223-4412
Mailing Address - Fax:423-663-8980
Practice Address - Street 1:378 OLD BRIMSTONE RD
Practice Address - Street 2:
Practice Address - City:HELENWOOD
Practice Address - State:TN
Practice Address - Zip Code:37755-5432
Practice Address - Country:US
Practice Address - Phone:423-223-4412
Practice Address - Fax:423-663-8980
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-03
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000090219164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse