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General NPI Number Information
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NPI Number | 1487047775
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Entity Type | Individual
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Provider Name | DONETTE RAE SURVANCE NP
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Gender | Female
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Dates
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Enumeration Date | 03/10/2015
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Last Update Date | 01/29/2018
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Provider Practice Location Address
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Address Line | 4749 BERRY BLVD
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City | MONTGOMERY
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State | AL
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Zip | 36106-3079
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Country | US
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Telephone | 334-747-8850
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Fax | 334-747-8860
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Provider Business Mailing Address
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Address Line | 301 BROWN SPRINGS RD
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City | MONTGOMERY
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State | AL
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Zip | 36117-7005
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Country | US
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Telephone | 334-273-4159
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Fax | 334-273-4290
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 19336
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1-161525
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License Number State | AL
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