Provider Demographics
NPI:1598904419
Name:BLACKWELL, DONNA FALL (BSN, RNC, NNP)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:FALL
Last Name:BLACKWELL
Suffix:
Gender:F
Credentials:BSN, RNC, NNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 6591
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44706
Mailing Address - Country:US
Mailing Address - Phone:216-219-1500
Mailing Address - Fax:
Practice Address - Street 1:2600 6TH STREET
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44710
Practice Address - Country:US
Practice Address - Phone:330-430-7435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-17
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP-06990363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care