Provider Demographics
NPI:1619353612
Name:ANDERSON, DONNA NICOLE (FNP)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:NICOLE
Last Name:ANDERSON
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 1:123 SUNNYBROOK RD
Mailing Address - Street 2:APT. 240
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-2783
Mailing Address - Country:US
Mailing Address - Phone:919-322-9246
Mailing Address - Fax:919-882-9270
Practice Address - Street 1:123 SUNNYBROOK RD
Practice Address - Street 2:#140
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-2783
Practice Address - Country:US
Practice Address - Phone:919-322-9246
Practice Address - Fax:919-882-9270
Is Sole Proprietor?:No
Enumeration Date:2015-08-03
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5007828363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health