Provider Demographics
NPI:1538636477
Name:DONELSON, RENEE (NP-C)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:DONELSON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 ELGIN LN
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28115-5786
Mailing Address - Country:US
Mailing Address - Phone:047-347-9384
Mailing Address - Fax:
Practice Address - Street 1:11780 US HIGHWAY 1 STE N107
Practice Address - Street 2:
Practice Address - City:NORTH PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33408-3007
Practice Address - Country:US
Practice Address - Phone:704-347-9384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-29
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP019504363L00000X
NC5013851363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner