Provider Demographics
NPI:1447407481
Name:OSWALD, DONNA LOUISE (PAC CERTIFIED PHYSIC)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:LOUISE
Last Name:OSWALD
Suffix:
Gender:F
Credentials:PAC CERTIFIED PHYSIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7155 E 38TH AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80207-1630
Mailing Address - Country:US
Mailing Address - Phone:303-321-7526
Mailing Address - Fax:303-861-0268
Practice Address - Street 1:7155 E 38TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80207-1630
Practice Address - Country:US
Practice Address - Phone:303-321-7526
Practice Address - Fax:303-861-0268
Is Sole Proprietor?:No
Enumeration Date:2008-08-21
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601003289207V00000X
COPA.0003097363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO36779270Medicaid