Provider Demographics
NPI:1972066561
Name:MAYHEW, DONNA
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:MAYHEW
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 1:2016 MELROSE AVE
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19013-5524
Mailing Address - Country:US
Mailing Address - Phone:718-738-2625
Mailing Address - Fax:
Practice Address - Street 1:3421 N 11TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-5434
Practice Address - Country:US
Practice Address - Phone:407-738-2625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-10
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211588164W00000X
PAPN319370164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse