Provider Demographics
NPI:1629550249
Name:MARVELS, DONNISHA
Entity Type:Individual
Prefix:
First Name:DONNISHA
Middle Name:
Last Name:MARVELS
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 1:4106 COLLEGE DR APT 713
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75901-7378
Mailing Address - Country:US
Mailing Address - Phone:903-570-1714
Mailing Address - Fax:
Practice Address - Street 1:4106 COLLEGE DR APT 713
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75901-7378
Practice Address - Country:US
Practice Address - Phone:903-570-1714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-30
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX341259164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse