Provider Demographics
NPI:1952458143
Name:HYLTON-LAWRENCE LUMBSDEN, DONETTE CHARISSEE (RN)
Entity Type:Individual
Prefix:MRS
First Name:DONETTE
Middle Name:CHARISSEE
Last Name:HYLTON-LAWRENCE LUMBSDEN
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 1:9955 AMHERST AVE
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91763-3002
Mailing Address - Country:US
Mailing Address - Phone:909-282-6822
Mailing Address - Fax:
Practice Address - Street 1:9955 AMHERST AVE
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763-3002
Practice Address - Country:US
Practice Address - Phone:909-282-6822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA512078163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARVN002570Medicaid