Provider Demographics
NPI:1407136013
Name:DONLEY, CINAMON L (NP-C)
Entity Type:Individual
Prefix:
First Name:CINAMON
Middle Name:L
Last Name:DONLEY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:CINAMON
Other - Middle Name:L
Other - Last Name:VAN HORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:11109 PARKVIEW PLAZA DR # 117
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8028 CARNEGIE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-5789
Practice Address - Country:US
Practice Address - Phone:260-422-7455
Practice Address - Fax:260-422-4125
Is Sole Proprietor?:No
Enumeration Date:2011-08-26
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71003822A363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000747983OtherANTHEM
IN201046750Medicaid
INM400062463Medicare PIN