Provider Demographics
NPI:1346556370
Name:PROVANCE, DONNA L (LPN)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:L
Last Name:PROVANCE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2187 25TH ST. S.W.
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44314-2201
Mailing Address - Country:US
Mailing Address - Phone:330-697-2010
Mailing Address - Fax:
Practice Address - Street 1:2187 25TH ST. S.W.
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44314-2201
Practice Address - Country:US
Practice Address - Phone:330-697-2010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-27
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN. 015913164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse