Provider Demographics
NPI:1659062503
Name:DONITHAN, PAUL H
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:H
Last Name:DONITHAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 AIRPORT RD STE 101
Mailing Address - Street 2:
Mailing Address - City:BLUEFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:24701-7388
Mailing Address - Country:US
Mailing Address - Phone:304-325-0066
Mailing Address - Fax:304-325-0077
Practice Address - Street 1:545 AIRPORT RD STE 101
Practice Address - Street 2:
Practice Address - City:BLUEFIELD
Practice Address - State:WV
Practice Address - Zip Code:24701-7388
Practice Address - Country:US
Practice Address - Phone:304-325-0066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-19
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV29501164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse