Provider Demographics
NPI:1124370523
Name:ROLLINS, DONNA JEAN (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:JEAN
Last Name:ROLLINS
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4251 BARTLETT ST
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:AK
Mailing Address - Zip Code:99603-7006
Mailing Address - Country:US
Mailing Address - Phone:907-235-7202
Mailing Address - Fax:907-235-7228
Practice Address - Street 1:4251 BARTLETT ST
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:AK
Practice Address - Zip Code:99603-7006
Practice Address - Country:US
Practice Address - Phone:907-235-7202
Practice Address - Fax:907-235-7228
Is Sole Proprietor?:No
Enumeration Date:2012-10-09
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1477363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1624871Medicaid