Provider Demographics
NPI:1073796454
Name:DONNELLY INC.
Entity Type:Organization
Organization Name:DONNELLY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DOLORES
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DONNELLY
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:443-538-6115
Mailing Address - Street 1:4608 OAKVIEW CT
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-5938
Mailing Address - Country:US
Mailing Address - Phone:443-538-6115
Mailing Address - Fax:301-754-2503
Practice Address - Street 1:3203 TOWER OAKS BLVD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-4258
Practice Address - Country:US
Practice Address - Phone:240-747-5650
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-09
Last Update Date:2007-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR051280367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty