Provider Demographics
NPI:1619142411
Name:DONNELLAN, MONICA JANE (RDH BS)
Entity Type:Individual
Prefix:MS
First Name:MONICA
Middle Name:JANE
Last Name:DONNELLAN
Suffix:
Gender:F
Credentials:RDH BS
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Other - Credentials:
Mailing Address - Street 1:620 W CLAIREMONT AVE
Mailing Address - Street 2:CHIPPEWA VALLEY TECHNICAL COLLEGE DENTAL HYGIENE PROGRA
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701
Mailing Address - Country:US
Mailing Address - Phone:715-833-6370
Mailing Address - Fax:715-833-6447
Practice Address - Street 1:620 W CLAIREMONT AVE
Practice Address - Street 2:CHIPPEWA VALLEY TECHNICAL COLLEGE DENTAL HYGIENE PROGRA
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701
Practice Address - Country:US
Practice Address - Phone:715-833-6370
Practice Address - Fax:715-833-6447
Is Sole Proprietor?:No
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI1001757016124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist