Individual
MRS. DONETTE RAE SURVANCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
4749 BERRY BLVD, MONTGOMERY, AL 36106-3079
(334) 747-8850
(334) 747-8860
Mailing address
301 BROWN SPRINGS RD, MONTGOMERY, AL 36117-7005
(334) 273-4159
(334) 273-4290
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
1-161525
AL
363LF0000X
Family Nurse Practitioner
19336
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
102I506794
MEDICARE
AL
05
—
206270
—
AL
01
—
512-1203
BCBS
AL
Enumeration date
03/10/2015
Last updated
01/29/2018
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