Provider Demographics
NPI:1689084345
Name:MARTY, DONNA (LPN)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:
Last Name:MARTY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:ORRVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44667-1815
Mailing Address - Country:US
Mailing Address - Phone:330-201-2021
Mailing Address - Fax:
Practice Address - Street 1:704 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:ORRVILLE
Practice Address - State:OH
Practice Address - Zip Code:44667-1815
Practice Address - Country:US
Practice Address - Phone:330-201-2021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-04
Last Update Date:2014-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN301641164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse