1104962406 NPI number — MRS. SARA LYNN DONALDSON RN RNP

Table of content: MRS. SARA LYNN DONALDSON RN RNP (NPI 1104962406)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104962406 NPI number — MRS. SARA LYNN DONALDSON RN RNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DONALDSON
Provider First Name:
SARA
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RN RNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104962406
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1712 GEORGETOWN CIRCLE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PARAGOULD
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72450
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-239-3111
Provider Business Mailing Address Fax Number:
870-239-6329

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
801 GOLDSMITH ROAD
Provider Second Line Business Practice Location Address:
GREENE COUNTY HEALTH DEPT
Provider Business Practice Location Address City Name:
PARAGOULD
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72450
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-236-7782
Provider Business Practice Location Address Fax Number:
870-239-6329
Provider Enumeration Date:
01/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  R13348 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 363L00000X , with the licence number: P00208 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com