Provider Demographics
NPI:1093343949
Name:DONNER, ANGELA (LPN)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:DONNER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 KATHLEEN CIR
Mailing Address - Street 2:
Mailing Address - City:PHENIX CITY
Mailing Address - State:AL
Mailing Address - Zip Code:36869-5619
Mailing Address - Country:US
Mailing Address - Phone:334-540-3808
Mailing Address - Fax:
Practice Address - Street 1:1602 BROAD ST
Practice Address - Street 2:
Practice Address - City:PHENIX CITY
Practice Address - State:AL
Practice Address - Zip Code:36867-5081
Practice Address - Country:US
Practice Address - Phone:334-540-3808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-27
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X, 251S00000X, 261QM0855X
AL2-050124164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No164W00000XNursing Service ProvidersLicensed Practical Nurse
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health