Provider Demographics
NPI:1578970695
Name:LEWELLEN, DONNA (LPN)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:LEWELLEN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41817B LOOP RD
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:NC
Mailing Address - Zip Code:28128-7767
Mailing Address - Country:US
Mailing Address - Phone:910-220-9300
Mailing Address - Fax:
Practice Address - Street 1:284 EXECUTIVE PARK DR
Practice Address - Street 2:SUITE 100
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-1831
Practice Address - Country:US
Practice Address - Phone:704-939-1100
Practice Address - Fax:704-939-1173
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-21
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC64628314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility