Provider Demographics
NPI:1467489500
Name:TUDOR, DONNA E (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:E
Last Name:TUDOR
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:482 INTERSTATE DR
Mailing Address - Street 2:STE A
Mailing Address - City:MANCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37355-3109
Mailing Address - Country:US
Mailing Address - Phone:931-728-4718
Mailing Address - Fax:931-728-1016
Practice Address - Street 1:482 INTERSTATE DR
Practice Address - Street 2:STE A
Practice Address - City:MANCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37355-3109
Practice Address - Country:US
Practice Address - Phone:931-728-4718
Practice Address - Fax:931-728-1016
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN61229363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3730155Medicaid
4107892OtherBC
TN3730155Medicaid
TN3348218Medicare ID - Type Unspecified
4107892OtherBC