Provider Demographics
NPI:1851413967
Name:ROCKWELL, DONNA R (CRNA,PC)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:R
Last Name:ROCKWELL
Suffix:
Gender:F
Credentials:CRNA,PC
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 292968
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75029-2968
Mailing Address - Country:US
Mailing Address - Phone:866-397-4219
Mailing Address - Fax:940-458-2902
Practice Address - Street 1:6110 SHERRY LN HIGHLAND PARK PLASTIC SURGERY CENTER
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225
Practice Address - Country:US
Practice Address - Phone:817-929-4471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32072367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXCRD0RF576Medicaid
TXRF57OtherBLUE CROSS
TXCRD0RF576Medicaid
TXRF57OtherBLUE CROSS