Provider Demographics
NPI:1083336192
Name:BURRELL, DONNA (CHW)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:BURRELL
Suffix:
Gender:F
Credentials:CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23077 GREENFIELD RD STE 200
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-3750
Mailing Address - Country:US
Mailing Address - Phone:313-824-1000
Mailing Address - Fax:248-569-9151
Practice Address - Street 1:23077 GREENFIELD RD STE 200
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-3750
Practice Address - Country:US
Practice Address - Phone:313-824-1000
Practice Address - Fax:248-569-9151
Is Sole Proprietor?:No
Enumeration Date:2022-09-15
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MINONEOtherNONE