Provider Demographics
NPI:1689709149
Name:POLEN, DONNA DARLENE (CNP)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:DARLENE
Last Name:POLEN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 449
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-0449
Mailing Address - Country:US
Mailing Address - Phone:740-374-4500
Mailing Address - Fax:740-374-5887
Practice Address - Street 1:210 N 7TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-2244
Practice Address - Country:US
Practice Address - Phone:740-376-0490
Practice Address - Fax:740-376-0438
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.08621.NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000733078OtherANTHEM
WV3810018814Medicaid
OHP01207861OtherRAILROAD MEDICARE
OH000000680677OtherANTHEM
OH2811201Medicaid
OH000000699828OtherANTHEM
OHNP26352Medicare PIN
WV3810018814Medicaid
OHNP86791Medicare PIN