Provider Demographics
NPI:1336766476
Name:DONAHUE, NADINE L (NP)
Entity Type:Individual
Prefix:
First Name:NADINE
Middle Name:L
Last Name:DONAHUE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1703 OGLETHORPE DR NE
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30319-2791
Mailing Address - Country:US
Mailing Address - Phone:580-483-9499
Mailing Address - Fax:
Practice Address - Street 1:1703 OGLETHORPE DR NE
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30319-2791
Practice Address - Country:US
Practice Address - Phone:580-483-9499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-05
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA292150363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health