=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255462214
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DONNA RENEE APPLETON CRNA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/08/2007
-----------------------------------------------------
Last Update Date | 03/21/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1701 PELHAM RD S
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36265-3353
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-782-4523
-----------------------------------------------------
Fax | 256-782-4184
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1547
-----------------------------------------------------
City | SEDALIA
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65302-1547
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 660-826-5960
-----------------------------------------------------
Fax | 660-826-4852
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 367500000X
-----------------------------------------------------
Taxonomy Name | Certified Registered Nurse Anesthetist
-----------------------------------------------------
License Number | 1-43489
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------