Provider Demographics
NPI:1093051419
Name:MIERZWA, DONNA C
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:C
Last Name:MIERZWA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5262 S STAPLES ST STE 211
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-4127
Mailing Address - Country:US
Mailing Address - Phone:361-461-3246
Mailing Address - Fax:361-334-8418
Practice Address - Street 1:5262 S STAPLES ST STE 211
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-4127
Practice Address - Country:US
Practice Address - Phone:361-461-3246
Practice Address - Fax:361-334-8418
Is Sole Proprietor?:No
Enumeration Date:2012-12-13
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1729246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic