Healthcare Provider Details

I. General information

NPI: 1386674612
Provider Name (Legal Business Name): DONA MICHELLE TUTEN II NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 07/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 MORAN DR
BONAIRE GA
31005-5106
US

IV. Provider business mailing address

106 MORAN DR
BONAIRE GA
31005-5106
US

V. Phone/Fax

Practice location:
  • Phone: 478-988-1282
  • Fax: 478-988-3120
Mailing address:
  • Phone: 478-988-1282
  • Fax: 478-988-3120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN140344
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: