Provider Demographics
NPI:1417180258
Name:BELLA DONNA
Entity Type:Organization
Organization Name:BELLA DONNA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:C
Authorized Official - Last Name:GOSSETT
Authorized Official - Suffix:
Authorized Official - Credentials:CFM
Authorized Official - Phone:517-610-7086
Mailing Address - Street 1:10482 FERRIS DR
Mailing Address - Street 2:
Mailing Address - City:CEMENT CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49233-9611
Mailing Address - Country:US
Mailing Address - Phone:517-610-7086
Mailing Address - Fax:
Practice Address - Street 1:10482 FERRIS DR
Practice Address - Street 2:
Practice Address - City:CEMENT CITY
Practice Address - State:MI
Practice Address - Zip Code:49233-9611
Practice Address - Country:US
Practice Address - Phone:517-610-7086
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-27
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier