Provider Demographics
NPI:1114269370
Name:DONOHUE, PAULA BLACK
Entity Type:Individual
Prefix:MS
First Name:PAULA
Middle Name:BLACK
Last Name:DONOHUE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PAULA
Other - Middle Name:JANE
Other - Last Name:BLACK-DONOHUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, RN, FNP-BC
Mailing Address - Street 1:PO BOX 457
Mailing Address - Street 2:
Mailing Address - City:SHEPHERDSTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:25443-0457
Mailing Address - Country:US
Mailing Address - Phone:304-876-8156
Mailing Address - Fax:
Practice Address - Street 1:250 SPRING WARBLER WAY
Practice Address - Street 2:
Practice Address - City:SHEPHERDSTOWN
Practice Address - State:WV
Practice Address - Zip Code:25443-4521
Practice Address - Country:US
Practice Address - Phone:304-876-8156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-25
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV59200163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse