Provider Demographics
NPI:1699833269
Name:FOORD, DONNA J (PA-C)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:J
Last Name:FOORD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 N. DIVISION AVE
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83856-8664
Mailing Address - Country:US
Mailing Address - Phone:208-263-1345
Mailing Address - Fax:208-255-5531
Practice Address - Street 1:1301 N DIVISION AVE
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-8268
Practice Address - Country:US
Practice Address - Phone:208-263-1345
Practice Address - Fax:208-255-5531
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPA-156363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID002619600Medicaid
ID002619600Medicaid