Provider Demographics
NPI:1912608191
Name:FEARON, DONNA (NP)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:
Last Name:FEARON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8007 BAILEYS LN
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-4633
Mailing Address - Country:US
Mailing Address - Phone:440-847-9463
Mailing Address - Fax:440-847-9463
Practice Address - Street 1:8007 BAILEYS LN
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-4633
Practice Address - Country:US
Practice Address - Phone:440-847-9463
Practice Address - Fax:440-847-9463
Is Sole Proprietor?:No
Enumeration Date:2023-03-14
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR172854363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care