Provider Demographics
NPI:1881747269
Name:STREET, DONNA S (MSN, APRN)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:S
Last Name:STREET
Suffix:
Gender:F
Credentials:MSN, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8745 S EMERSON AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-9400
Mailing Address - Country:US
Mailing Address - Phone:317-807-0409
Mailing Address - Fax:317-807-0410
Practice Address - Street 1:8745 S EMERSON AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-9400
Practice Address - Country:US
Practice Address - Phone:317-807-0409
Practice Address - Fax:317-807-0410
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002557A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN248520EEEMedicare PIN
IN251320TMedicare PIN