Provider Demographics
NPI:1629184023
Name:MCMAHAN, DONNA WELFEL (RN MSN FNP)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:WELFEL
Last Name:MCMAHAN
Suffix:
Gender:F
Credentials:RN MSN FNP
Other - Prefix:
Other - First Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1731 W WHEELER
Mailing Address - Street 2:
Mailing Address - City:ARANSAS PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78336
Mailing Address - Country:US
Mailing Address - Phone:361-758-5326
Mailing Address - Fax:361-758-2137
Practice Address - Street 1:2413 MEMORIAL PKWY
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:TX
Practice Address - Zip Code:78374-3209
Practice Address - Country:US
Practice Address - Phone:361-643-4546
Practice Address - Fax:361-643-7986
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX518553207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX112554401Medicaid
TX813759OtherBCBS
TX112554401Medicaid
CP2136Medicare PIN