Provider Demographics
NPI:1891773370
Name:PRELOG, DONNA JEANNE (CNM)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:JEANNE
Last Name:PRELOG
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2051 HAMILL RD
Mailing Address - Street 2:STE 400
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-6606
Mailing Address - Country:US
Mailing Address - Phone:423-877-4549
Mailing Address - Fax:423-875-8510
Practice Address - Street 1:2051 HAMILL RD
Practice Address - Street 2:STE 400
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-6606
Practice Address - Country:US
Practice Address - Phone:423-877-4549
Practice Address - Fax:423-875-8510
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN10580367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNAPN10580OtherMEDICAL LICENSURE
TNAPN10580OtherMEDICAL LICENSURE