Provider Demographics
NPI:1013520626
Name:DONITZEN, JESSICA DAWN
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:DAWN
Last Name:DONITZEN
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:PO BOX 33
Mailing Address - Street 2:
Mailing Address - City:HINTON
Mailing Address - State:WV
Mailing Address - Zip Code:25951-0033
Mailing Address - Country:US
Mailing Address - Phone:304-445-6200
Mailing Address - Fax:
Practice Address - Street 1:971 TUG CREEK MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:HINTON
Practice Address - State:WV
Practice Address - Zip Code:25951-8800
Practice Address - Country:US
Practice Address - Phone:304-445-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-25
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant