Provider Demographics
NPI:1487857827
Name:DONAT, LISA JEAN (RN)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:JEAN
Last Name:DONAT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 1ST AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-4848
Mailing Address - Country:US
Mailing Address - Phone:907-452-8251
Mailing Address - Fax:907-459-3985
Practice Address - Street 1:201 1ST AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4848
Practice Address - Country:US
Practice Address - Phone:907-452-8251
Practice Address - Fax:907-459-3985
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK12348171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCM3480Medicaid