Provider Demographics
NPI:1679174452
Name:GOLMAN, DONNA SHARTIL
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:SHARTIL
Last Name:GOLMAN
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 1:73350 BIRDIE STREET
Mailing Address - Street 2:
Mailing Address - City:ABITA SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70420
Mailing Address - Country:US
Mailing Address - Phone:985-415-6522
Mailing Address - Fax:
Practice Address - Street 1:73350 BIRDIE STREET
Practice Address - Street 2:
Practice Address - City:ABITA SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70420
Practice Address - Country:US
Practice Address - Phone:985-415-6522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA009262060172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver