Provider Demographics
NPI:1932659042
Name:BARTLETT, DONNA (RN)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:
Last Name:BARTLETT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 LAKEWOOD POINT DR
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-2061
Mailing Address - Country:US
Mailing Address - Phone:318-746-4653
Mailing Address - Fax:
Practice Address - Street 1:118 LAKEWOOD POINT DR
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-2061
Practice Address - Country:US
Practice Address - Phone:318-746-4653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-12
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA058455163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA$$$$$$$$$Medicaid