Provider Demographics
NPI:1417283888
Name:MAYS, DONNA JEAN (LPN)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:JEAN
Last Name:MAYS
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 1:3RD AVENUE AND INNER LOOP ROAD
Mailing Address - Street 2:BLDG 166
Mailing Address - City:FORT IRWIN
Mailing Address - State:CA
Mailing Address - Zip Code:92310
Mailing Address - Country:US
Mailing Address - Phone:760-380-4766
Mailing Address - Fax:760-380-5276
Practice Address - Street 1:3RD AVENUE AND INNER LOOP ROAD
Practice Address - Street 2:BLDG 166
Practice Address - City:FORT IRWIN
Practice Address - State:CA
Practice Address - Zip Code:92310
Practice Address - Country:US
Practice Address - Phone:760-380-4766
Practice Address - Fax:760-380-5276
Is Sole Proprietor?:No
Enumeration Date:2009-10-20
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL043.101362164W00000X
CAVN223078164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse