Provider Demographics
NPI:1073603569
Name:KING, DONNA SUE (MSN, CNS)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:SUE
Last Name:KING
Suffix:
Gender:F
Credentials:MSN, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 E MARKET ST
Mailing Address - Street 2:PO BOX 2090
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44304-1619
Mailing Address - Country:US
Mailing Address - Phone:330-996-0347
Mailing Address - Fax:330-996-0359
Practice Address - Street 1:525 E MARKET ST
Practice Address - Street 2:STE 3-E
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44304-1619
Practice Address - Country:US
Practice Address - Phone:330-375-5100
Practice Address - Fax:330-379-5177
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH130581364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3123471Medicaid