Healthcare Provider Details

I. General information

NPI: 1770913386
Provider Name (Legal Business Name): DONITA TORRES RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2013
Last Update Date: 11/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8295 TOURNAMENT DR STE 150
MEMPHIS TN
38125-8900
US

IV. Provider business mailing address

408 W BRINKLEY LOOP APT 5
MARION AR
72364-5048
US

V. Phone/Fax

Practice location:
  • Phone: 866-563-7772
  • Fax:
Mailing address:
  • Phone: 901-569-6927
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR79276
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: