Provider Demographics
NPI:1336417096
Name:DONATH, GAYLE E (LPN)
Entity Type:Individual
Prefix:
First Name:GAYLE
Middle Name:E
Last Name:DONATH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 MILLVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-1643
Mailing Address - Country:US
Mailing Address - Phone:810-538-2020
Mailing Address - Fax:810-538-2001
Practice Address - Street 1:25 MILLVILLE RD
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-1643
Practice Address - Country:US
Practice Address - Phone:810-538-2020
Practice Address - Fax:810-538-2001
Is Sole Proprietor?:No
Enumeration Date:2011-12-09
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703041293164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse