Provider Demographics
NPI:1215527395
Name:BLACKWELL, DONNA (RN)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:BLACKWELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:100 ELMWOOD PARK DR STE 201
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45449-5402
Mailing Address - Country:US
Mailing Address - Phone:937-384-0580
Mailing Address - Fax:937-384-0581
Practice Address - Street 1:113 E CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WEST CARROLLTON
Practice Address - State:OH
Practice Address - Zip Code:45449-1843
Practice Address - Country:US
Practice Address - Phone:937-247-9015
Practice Address - Fax:937-247-9009
Is Sole Proprietor?:No
Enumeration Date:2021-01-22
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OHRN.140900163WA0400X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)