Provider Demographics
NPI:1528248473
Name:SUTTON, DONNA M (LPN)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:M
Last Name:SUTTON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 RORIE HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:INDIAN MOUND
Mailing Address - State:TN
Mailing Address - Zip Code:37079-5331
Mailing Address - Country:US
Mailing Address - Phone:931-232-5068
Mailing Address - Fax:
Practice Address - Street 1:530 RORIE HOLLOW RD
Practice Address - Street 2:
Practice Address - City:INDIAN MOUND
Practice Address - State:TN
Practice Address - Zip Code:37079-5331
Practice Address - Country:US
Practice Address - Phone:931-232-5068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-08
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN28946164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN28946OtherLPN