Provider Demographics
NPI:1427219534
Name:DICKENS, DONNA HOOTEN (CFM, CFTS)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:HOOTEN
Last Name:DICKENS
Suffix:
Gender:F
Credentials:CFM, CFTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27856-1737
Mailing Address - Country:US
Mailing Address - Phone:252-462-0500
Mailing Address - Fax:252-462-0521
Practice Address - Street 1:625 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:NC
Practice Address - Zip Code:27856-1737
Practice Address - Country:US
Practice Address - Phone:252-462-0500
Practice Address - Fax:252-462-0521
Is Sole Proprietor?:No
Enumeration Date:2008-06-20
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC550174400000X
NCCFM00904174400000X
NCCFTS0549225000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
No174400000XOther Service ProvidersSpecialist