Provider Demographics
NPI:1629785407
Name:HAUN, DONNELLE ADRIAN
Entity Type:Individual
Prefix:MRS
First Name:DONNELLE
Middle Name:ADRIAN
Last Name:HAUN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DONNELLE
Other - Middle Name:ANTOINETTE
Other - Last Name:ADRIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3033 N FIVE MILE RD APT 104
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-5280
Mailing Address - Country:US
Mailing Address - Phone:805-270-0390
Mailing Address - Fax:
Practice Address - Street 1:7297 MCDERMOTT RD
Practice Address - Street 2:
Practice Address - City:KUNA
Practice Address - State:ID
Practice Address - Zip Code:83634-1501
Practice Address - Country:US
Practice Address - Phone:208-314-4502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-01
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician