Provider Demographics
NPI:1912350133
Name:DONAHUE, STEVEN
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:DONAHUE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1511 FARNAM ST
Mailing Address - Street 2:110
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68102-2228
Mailing Address - Country:US
Mailing Address - Phone:402-612-4728
Mailing Address - Fax:
Practice Address - Street 1:1511 FARNAM ST
Practice Address - Street 2:110
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68102-2228
Practice Address - Country:US
Practice Address - Phone:402-612-4728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-22
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEH13581397172A00000X
NE175T00000X
NE119512376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No172A00000XOther Service ProvidersDriver
No175T00000XOther Service ProvidersPeer Specialist