Provider Demographics
NPI:1447523139
Name:WALDEN, DONNA B (RN)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:B
Last Name:WALDEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 FINNCANNON DR
Mailing Address - Street 2:
Mailing Address - City:ELLIJAY
Mailing Address - State:GA
Mailing Address - Zip Code:30536-4773
Mailing Address - Country:US
Mailing Address - Phone:229-395-5771
Mailing Address - Fax:
Practice Address - Street 1:161 FINNCANNON DR
Practice Address - Street 2:
Practice Address - City:ELLIJAY
Practice Address - State:GA
Practice Address - Zip Code:30536-4773
Practice Address - Country:US
Practice Address - Phone:229-395-5771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-11
Last Update Date:2012-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA163WA2000X163WA2000X
GA163WC0400X163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator