Provider Demographics
NPI:1932192028
Name:NALL, DONNA SUE (MD)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:SUE
Last Name:NALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:402 BOGLE ST
Mailing Address - Street 2:SUITE #1
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-2870
Mailing Address - Country:US
Mailing Address - Phone:606-679-8696
Mailing Address - Fax:606-678-2517
Practice Address - Street 1:402 BOGLE ST
Practice Address - Street 2:SUITE #1
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-2870
Practice Address - Country:US
Practice Address - Phone:606-679-8696
Practice Address - Fax:606-678-2517
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY21433207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYC69913Medicare UPIN
KY1518401Medicare ID - Type Unspecified