Healthcare Provider Details

I. General information

NPI: 1447300603
Provider Name (Legal Business Name): DONNA BOALS SCHLESINGER DPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 HWY 45 BYPASS
MEDINA TN
38355
US

IV. Provider business mailing address

55 TURKEY CREEK RD
HUMBOLDT TN
38343-6804
US

V. Phone/Fax

Practice location:
  • Phone: 783-783-0777
  • Fax: 731-783-3005
Mailing address:
  • Phone: 731-783-3618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number6777
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: