Healthcare Provider Details

I. General information

NPI: 1861594939
Provider Name (Legal Business Name): DONNA M WHALEY CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 LEE ROAD 265
CUSSETA AL
36852-2944
US

IV. Provider business mailing address

410 LEE ROAD 265
CUSSETA AL
36852-2944
US

V. Phone/Fax

Practice location:
  • Phone: 334-275-9500
  • Fax: 888-527-5911
Mailing address:
  • Phone: 334-276-9500
  • Fax: 888-527-5911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1085743
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: