Provider Demographics
NPI:1154512416
Name:HEFNER, DONNA MARIE (PA)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:MARIE
Last Name:HEFNER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4701 NEWVILLE PL
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92509-4036
Mailing Address - Country:US
Mailing Address - Phone:951-681-9442
Mailing Address - Fax:
Practice Address - Street 1:126 AVOCADO AVE
Practice Address - Street 2:STE 106
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92571-2605
Practice Address - Country:US
Practice Address - Phone:951-943-7212
Practice Address - Fax:951-943-4938
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA18756363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant