Provider Demographics
NPI:1780232454
Name:DONALD, IRENE T
Entity Type:Individual
Prefix:MRS
First Name:IRENE
Middle Name:T
Last Name:DONALD
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 1:29620 BAYSHORE DR N
Mailing Address - Street 2:
Mailing Address - City:ORANGE BEACH
Mailing Address - State:AL
Mailing Address - Zip Code:36561-4201
Mailing Address - Country:US
Mailing Address - Phone:251-610-8063
Mailing Address - Fax:
Practice Address - Street 1:29620 BAYSHORE DR N
Practice Address - Street 2:
Practice Address - City:ORANGE BEACH
Practice Address - State:AL
Practice Address - Zip Code:36561-4201
Practice Address - Country:US
Practice Address - Phone:251-610-8063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-27
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALMBG822283548OtherSELF