Provider Demographics
NPI:1235435058
Name:DONOVAN, GLENDA SUE
Entity Type:Individual
Prefix:MRS
First Name:GLENDA
Middle Name:SUE
Last Name:DONOVAN
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 1:803 NW 7TH ST
Mailing Address - Street 2:P.O. BOX 447
Mailing Address - City:STIGLER
Mailing Address - State:OK
Mailing Address - Zip Code:74462-2794
Mailing Address - Country:US
Mailing Address - Phone:918-967-8558
Mailing Address - Fax:
Practice Address - Street 1:803 NW 7TH ST
Practice Address - Street 2:
Practice Address - City:STIGLER
Practice Address - State:OK
Practice Address - Zip Code:74462-2794
Practice Address - Country:US
Practice Address - Phone:918-967-8558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-27
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator