Provider Demographics
NPI:1295873768
Name:GAU-JATA, DONNA M (CNM)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:M
Last Name:GAU-JATA
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:M
Other - Last Name:GAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 WYOMING ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45409-2722
Mailing Address - Country:US
Mailing Address - Phone:937-208-2007
Mailing Address - Fax:
Practice Address - Street 1:1 WYOMING ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409-2722
Practice Address - Country:US
Practice Address - Phone:937-208-2007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-04
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNM-00031367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHNM-00031OtherCERTIFIED NURSE-MIDWIFE
OHRX 00031OtherCERT. TO PRESCRIBE
OH214755OtherRN LICENSE
OH0819529Medicaid