Provider Demographics
NPI:1194488403
Name:DAVIDSON, DONNA SANDERSON (FNP)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:SANDERSON
Last Name:DAVIDSON
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 1:208 LORRIN LN
Mailing Address - Street 2:
Mailing Address - City:STERRETT
Mailing Address - State:AL
Mailing Address - Zip Code:35147-9536
Mailing Address - Country:US
Mailing Address - Phone:843-655-7663
Mailing Address - Fax:
Practice Address - Street 1:208 LORRIN LN
Practice Address - Street 2:
Practice Address - City:STERRETT
Practice Address - State:AL
Practice Address - Zip Code:35147-9536
Practice Address - Country:US
Practice Address - Phone:843-655-7663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-14
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-078074363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily