Provider Demographics
NPI:1639142383
Name:TOWNSEND, DONNA MAE (NP)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:MAE
Last Name:TOWNSEND
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 BROADWAY ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79401-3277
Mailing Address - Country:US
Mailing Address - Phone:806-765-2611
Mailing Address - Fax:
Practice Address - Street 1:2301 CEDAR AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79404-1629
Practice Address - Country:US
Practice Address - Phone:806-749-0024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX450977363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX04144841Medicaid
TX04144841Medicaid
82N189Medicare ID - Type Unspecified