MEDICARE: MS. DONISHA DAWN PARDUE NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	AP3181	AZ

General Provider Information

NPI Number	:	1902052954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DONISHA DAWN PARDUE NP

Provider Business Mailing Address
First Line	:	815 RIVERVIEW DR
Second Line	:
City	:	FLORENCE
State	:	AL
Zip	:	35630-5927
Country	:	US
Telephone Number	:	603-957-0540
Fax Number	:

Provider Business Practice Location Address
First Line	:	3606 E BASELINE RD
Second Line	:	#209
City	:	PHOENIX
State	:	AZ
Zip	:	85042-7202
Country	:	US
Telephone Number	:	603-957-0540
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2008
Last Update Date	:	01/05/2016

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