Provider Demographics
NPI:1487858122
Name:CHANG, DONNA G
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:G
Last Name:CHANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:G
Other - Last Name:CHANG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BSN,RN
Mailing Address - Street 1:PO BOX 46875
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45246-0875
Mailing Address - Country:US
Mailing Address - Phone:513-545-8169
Mailing Address - Fax:513-648-9664
Practice Address - Street 1:11791 ROSE LN
Practice Address - Street 2:SUITE D
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45246-2334
Practice Address - Country:US
Practice Address - Phone:513-545-8169
Practice Address - Fax:513-648-9664
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN246130163W00000X, 163WC0200X, 163WC1500X, 163WM1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
Not Answered163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Not Answered163WM1400XNursing Service ProvidersRegistered NurseNurse Massage Therapist (NMT)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2633690Medicaid