Provider Demographics
NPI:1003390956
Name:HERROD, DONTA STEVE
Entity Type:Individual
Prefix:
First Name:DONTA
Middle Name:STEVE
Last Name:HERROD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5404 JAMES PL NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-7025
Mailing Address - Country:US
Mailing Address - Phone:240-417-2593
Mailing Address - Fax:
Practice Address - Street 1:4216 BENNING RD NE APT 204
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-4559
Practice Address - Country:US
Practice Address - Phone:202-398-2742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-17
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant