Provider Demographics
NPI:1407472293
Name:DONALDSON, RYSHON
Entity Type:Individual
Prefix:
First Name:RYSHON
Middle Name:
Last Name:DONALDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 SANDRA DEL MAR DR
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448-4748
Mailing Address - Country:US
Mailing Address - Phone:504-380-4535
Mailing Address - Fax:
Practice Address - Street 1:212 SANDRA DEL MAR DR
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70448-4748
Practice Address - Country:US
Practice Address - Phone:504-380-4535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-17
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver