Provider Demographics
NPI:1740498880
Name:DONEYHUE, WENDY GRIM (MD)
Entity type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:GRIM
Last Name:DONEYHUE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 W SAINT CLAIR ST
Mailing Address - Street 2:RM 1A
Mailing Address - City:WARREN
Mailing Address - State:PA
Mailing Address - Zip Code:16365-2187
Mailing Address - Country:US
Mailing Address - Phone:504-842-4000
Mailing Address - Fax:
Practice Address - Street 1:1000 OCHSNER BOULEVARD
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433
Practice Address - Country:US
Practice Address - Phone:985-639-3777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.201421207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1508101Medicaid
MS09357021Medicaid
MS09357021Medicaid
LA4N197Medicare PIN