Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | RN129689 | GA |
NPI | 1003282120 |
---|---|
Provider Name | Donna Jenkins Pause |
First Address | Monroe, GA 30655-8211 |
Second Address | Monroe, GA 30655-8211 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2015 |
Last Update Date | 16/02/2016 |