Provider Demographics
NPI:1356006225
Name:GREAVER, DONNA JEAN
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:JEAN
Last Name:GREAVER
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:PO BOX 5
Mailing Address - Street 2:
Mailing Address - City:LOST CREEK
Mailing Address - State:WV
Mailing Address - Zip Code:26385-0005
Mailing Address - Country:US
Mailing Address - Phone:304-629-2166
Mailing Address - Fax:
Practice Address - Street 1:36 WHEELER MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:LOST CREEK
Practice Address - State:WV
Practice Address - Zip Code:26385-7672
Practice Address - Country:US
Practice Address - Phone:304-629-2166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-04
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide