Provider Demographics
NPI:1194932657
Name:OPALKA, DONNA JEAN (RDLDN)
Entity type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:JEAN
Last Name:OPALKA
Suffix:
Gender:F
Credentials:RDLDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:728 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:FORD CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16226-1101
Mailing Address - Country:US
Mailing Address - Phone:724-763-7221
Mailing Address - Fax:724-463-8131
Practice Address - Street 1:5230 CENTRE AVE
Practice Address - Street 2:SCHOOL OF NURSING BLDG. SUITE 141
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15232-1304
Practice Address - Country:US
Practice Address - Phone:412-623-2421
Practice Address - Fax:412-623-2279
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN000443133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA070337RTRMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER