Provider Demographics
NPI:1013240597
Name:PURVIANCE, DONNA J (NP)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:J
Last Name:PURVIANCE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 W 16TH ST STE 5100
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-2274
Mailing Address - Country:US
Mailing Address - Phone:317-396-1300
Mailing Address - Fax:317-924-8472
Practice Address - Street 1:355 W 16TH ST STE 5100
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-2274
Practice Address - Country:US
Practice Address - Phone:317-396-1300
Practice Address - Fax:317-924-8472
Is Sole Proprietor?:No
Enumeration Date:2009-09-15
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71003014A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP00834683OtherRAILROAD MEDICARE
IN859920CCMedicare PIN
IN859910F5Medicare PIN
IN265130A9Medicare PIN
INP00834683OtherRAILROAD MEDICARE