Provider Demographics
NPI:1114139193
Name:MOUNCE, DONNA MARIE
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:MARIE
Last Name:MOUNCE
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 1:12 SCOTT ST.
Mailing Address - Street 2:P.O. BOX 144
Mailing Address - City:SAVANNAH
Mailing Address - State:OH
Mailing Address - Zip Code:44874
Mailing Address - Country:US
Mailing Address - Phone:419-908-8444
Mailing Address - Fax:
Practice Address - Street 1:12 SCOTT ST.
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:OH
Practice Address - Zip Code:44874
Practice Address - Country:US
Practice Address - Phone:419-908-8444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2597435Medicaid