Healthcare Provider Details

I. General information

NPI: 1669555702
Provider Name (Legal Business Name): DONNA E. HENDLEY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 VIRGINIA AVENUE
MILLEN GA
30442
US

IV. Provider business mailing address

PO BOX 627
MILLEN GA
30442-0627
US

V. Phone/Fax

Practice location:
  • Phone: 478-982-2811
  • Fax: 478-982-1589
Mailing address:
  • Phone: 478-982-2811
  • Fax: 478-982-1589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN130508
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: