Provider Demographics
NPI:1255702007
Name:DONNAN, JANE ELIZABETH
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:ELIZABETH
Last Name:DONNAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:E
Other - Last Name:DANIEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1313 E NORTH ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-1355
Mailing Address - Country:US
Mailing Address - Phone:770-355-1689
Mailing Address - Fax:
Practice Address - Street 1:1313 E NORTH ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-1355
Practice Address - Country:US
Practice Address - Phone:770-355-1689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-19
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2211501150367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered