Provider Demographics
NPI:1831213545
Name:BURROUGHS, DONNA D (APRN, CDE, CWCN)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:D
Last Name:BURROUGHS
Suffix:
Gender:F
Credentials:APRN, CDE, CWCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HEALTHY WAY
Mailing Address - Street 2:SUITE 1210
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-7915
Mailing Address - Country:US
Mailing Address - Phone:864-512-4160
Mailing Address - Fax:864-512-4165
Practice Address - Street 1:100 HEALTHY WAY
Practice Address - Street 2:SUITE 1210
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-7915
Practice Address - Country:US
Practice Address - Phone:864-512-4160
Practice Address - Fax:864-512-4165
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1888364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCN90824Medicaid
SCN90824Medicaid
SCQ480767111Medicare PIN
SCQ480767111Medicare PIN