Provider Demographics
NPI:1487042842
Name:HETTINGER, DONNA MICHELLE
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:MICHELLE
Last Name:HETTINGER
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 1:4370 MALSBARY RD STE 100
Mailing Address - Street 2:
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45242-5653
Mailing Address - Country:US
Mailing Address - Phone:513-791-1222
Mailing Address - Fax:
Practice Address - Street 1:260 STETSON ST STE 3200
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2472
Practice Address - Country:US
Practice Address - Phone:513-558-4936
Practice Address - Fax:513-558-5449
Is Sole Proprietor?:No
Enumeration Date:2015-01-07
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.17057363L00000X
OHRN.375481363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics