Provider Demographics
NPI:1386674612
Name:TUTEN, DONA MICHELLE II (NP)
Entity Type:Individual
Prefix:
First Name:DONA
Middle Name:MICHELLE
Last Name:TUTEN
Suffix:II
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 MORAN DR
Mailing Address - Street 2:
Mailing Address - City:BONAIRE
Mailing Address - State:GA
Mailing Address - Zip Code:31005-5106
Mailing Address - Country:US
Mailing Address - Phone:478-988-1282
Mailing Address - Fax:478-988-3120
Practice Address - Street 1:106 MORAN DR
Practice Address - Street 2:
Practice Address - City:BONAIRE
Practice Address - State:GA
Practice Address - Zip Code:31005-5106
Practice Address - Country:US
Practice Address - Phone:478-988-1282
Practice Address - Fax:478-988-3120
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN140344363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA616033987AMedicaid
GA616033987AMedicaid
GA50BBKKJMedicare PIN