Provider Demographics
NPI:1598366932
Name:BROEMSEN, DONNA JEAN
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:JEAN
Last Name:BROEMSEN
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 1:51904 STATE ROUTE 26
Mailing Address - Street 2:
Mailing Address - City:JERUSALEM
Mailing Address - State:OH
Mailing Address - Zip Code:43747-9729
Mailing Address - Country:US
Mailing Address - Phone:740-926-9845
Mailing Address - Fax:
Practice Address - Street 1:51904 STATE ROUTE 26
Practice Address - Street 2:
Practice Address - City:JERUSALEM
Practice Address - State:OH
Practice Address - Zip Code:43747-9729
Practice Address - Country:US
Practice Address - Phone:740-926-9845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3747P1801X
OH56002733747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH5600273Medicaid