Provider Demographics
NPI:1790788024
Name:BASS, DONNA WHITE (NP)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:WHITE
Last Name:BASS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 M AVE UNIT A
Mailing Address - Street 2:
Mailing Address - City:KURE BEACH
Mailing Address - State:NC
Mailing Address - Zip Code:28449-3830
Mailing Address - Country:US
Mailing Address - Phone:252-335-5319
Mailing Address - Fax:
Practice Address - Street 1:4005 OLEANDER DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6816
Practice Address - Country:US
Practice Address - Phone:910-790-9949
Practice Address - Fax:910-790-9455
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2012-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC800112363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC1647OtherMEDCOST
NC7005293Medicaid
NC80084FMedicare UPIN