Provider Demographics
NPI:1033592688
Name:DRIVER, DONNA MAE
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:MAE
Last Name:DRIVER
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:DONNA
Other - Middle Name:MAE
Other - Last Name:GILCREASE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:808 W WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88203-3864
Mailing Address - Country:US
Mailing Address - Phone:575-420-3829
Mailing Address - Fax:
Practice Address - Street 1:808 W WALNUT ST
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88203-3864
Practice Address - Country:US
Practice Address - Phone:575-420-3829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-01
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist