Provider Demographics
NPI:1720101132
Name:FENSKE, DONNA MARIE (BS, MA, MPH, MS)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:MARIE
Last Name:FENSKE
Suffix:
Gender:F
Credentials:BS, MA, MPH, MS
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 1204
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:AK
Mailing Address - Zip Code:99603-1204
Mailing Address - Country:US
Mailing Address - Phone:907-235-2563
Mailing Address - Fax:907-235-2566
Practice Address - Street 1:426 E BAYVIEW AVE
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:AK
Practice Address - Zip Code:99603-7117
Practice Address - Country:US
Practice Address - Phone:907-235-2563
Practice Address - Fax:907-235-2566
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK963363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily