Basic Information
Provider Information
NPI: 1083353262
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MARANDI
FirstName: DONYA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: FNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 210127
Address2:  
City: NASHVILLE
State: TN
PostalCode: 372210127
CountryCode: US
TelephoneNumber: 6153832443
FaxNumber: 6153830853
Practice Location
Address1: 330 22ND AVE N
Address2:  
City: NASHVILLE
State: TN
PostalCode: 372031844
CountryCode: US
TelephoneNumber: 6153200007
FaxNumber: 6153203183
Other Information
ProviderEnumerationDate: 06/03/2022
LastUpdateDate: 07/19/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/19/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363L00000X31808TNY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

No ID Information.


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