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Individual

DONNA E TUDOR

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
NURSE PRACTITIONER

Contact information

Practice address
482 INTERSTATE DR, STE A, MANCHESTER, TN 37355-3109
(931) 728-4718
(931) 728-1016
Mailing address
482 INTERSTATE DR, STE A, MANCHESTER, TN 37355-3109
(931) 728-4718
(931) 728-1016

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
RN61229
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
3730155
TN
01
4107892
BC
Enumeration date
06/26/2006
Last updated
11/01/2011
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