Provider Demographics
NPI:1700163235
Name:DONKAR, LAUREN REDDERSEN (PNP)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:REDDERSEN
Last Name:DONKAR
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 PIRKLE FERRY RD
Mailing Address - Street 2:SUITE J300
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-9201
Mailing Address - Country:US
Mailing Address - Phone:770-889-9142
Mailing Address - Fax:
Practice Address - Street 1:11 DUNWOODY PARK
Practice Address - Street 2:SUITE 190
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338-7408
Practice Address - Country:US
Practice Address - Phone:770-392-6555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-11
Last Update Date:2011-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN155467363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics