Provider Demographics
NPI:1730123118
Name:WHELAN, DONNA M (RD)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:M
Last Name:WHELAN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:M
Other - Last Name:MAAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-2812
Mailing Address - Country:US
Mailing Address - Phone:520-417-4994
Mailing Address - Fax:520-417-4979
Practice Address - Street 1:300 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2812
Practice Address - Country:US
Practice Address - Phone:520-417-4994
Practice Address - Fax:520-417-4979
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH13469133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH13469OtherCOMMISSION DIETETIC REGIS
AZ101942Medicare PIN