Provider Demographics
NPI:1235222373
Name:BEAVEN, DONNA LEE (NP)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:LEE
Last Name:BEAVEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 WILLOWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45066-8179
Mailing Address - Country:US
Mailing Address - Phone:484-269-7027
Mailing Address - Fax:
Practice Address - Street 1:4100 W 3RD ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45428-9000
Practice Address - Country:US
Practice Address - Phone:937-268-6511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAUP006352B363L00000X
OHCOA.11669-NP363LF0000X
OHRN.362377-COA1163W00000X
OHRX.11669-363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP00286813OtherRR MEDICARE
PABE1834847OtherBLUE SHIELD
Q20651Medicare UPIN
PA081551TNAMedicare ID - Type Unspecified