Provider Demographics
NPI:1164710455
Name:DAUGHERTY, DONNA D (RN)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:D
Last Name:DAUGHERTY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8115 BLUE SPRUCE DR
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-1215
Mailing Address - Country:US
Mailing Address - Phone:423-362-0917
Mailing Address - Fax:
Practice Address - Street 1:8115 BLUE SPRUCE DR
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-1215
Practice Address - Country:US
Practice Address - Phone:423-362-0917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-20
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN97224163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine