Provider Demographics
NPI:1548780430
Name:KILLEBREW, DONNA
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:KILLEBREW
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 1:8033 E 10 MILE RD STE 114
Mailing Address - Street 2:
Mailing Address - City:CENTER LINE
Mailing Address - State:MI
Mailing Address - Zip Code:48015-1454
Mailing Address - Country:US
Mailing Address - Phone:586-756-6661
Mailing Address - Fax:586-756-6933
Practice Address - Street 1:8033 E 10 MILE RD STE 114
Practice Address - Street 2:
Practice Address - City:CENTER LINE
Practice Address - State:MI
Practice Address - Zip Code:48015-1454
Practice Address - Country:US
Practice Address - Phone:586-756-6661
Practice Address - Fax:586-756-6933
Is Sole Proprietor?:No
Enumeration Date:2017-06-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703104020164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse