Provider Demographics
NPI:1881432284
Name:DONALDSON, PATRICE D (QMA)
Entity type:Individual
Prefix:
First Name:PATRICE
Middle Name:D
Last Name:DONALDSON
Suffix:
Gender:F
Credentials:QMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5629 LIBERTY CREEK DR E
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-1003
Mailing Address - Country:US
Mailing Address - Phone:317-492-3009
Mailing Address - Fax:
Practice Address - Street 1:5629 LIBERTY CREEK DR E
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-1003
Practice Address - Country:US
Practice Address - Phone:317-492-3009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-18
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN24-016264-13747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant