Provider Demographics
NPI:1295263077
Name:DONAHUE, ANTHONY THOMAS (RN)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:THOMAS
Last Name:DONAHUE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 PERRY ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44805-2025
Mailing Address - Country:US
Mailing Address - Phone:419-989-7439
Mailing Address - Fax:419-589-5054
Practice Address - Street 1:1451 LUCAS RD
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44903-8682
Practice Address - Country:US
Practice Address - Phone:419-589-5511
Practice Address - Fax:419-589-5054
Is Sole Proprietor?:No
Enumeration Date:2017-05-24
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.460417163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse