Provider Demographics
NPI:1316151673
Name:ROCK, DONNA JEAN (LPN)
Entity type:Individual
Prefix:MS
First Name:DONNA
Middle Name:JEAN
Last Name:ROCK
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:DONNA
Other - Middle Name:JEAN
Other - Last Name:HARBOLD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:3857 PILLSBURY AVE SO
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55409
Mailing Address - Country:US
Mailing Address - Phone:612-345-6844
Mailing Address - Fax:
Practice Address - Street 1:106 NORTH 4TH AVENUE
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-1034
Practice Address - Country:US
Practice Address - Phone:218-998-3778
Practice Address - Fax:218-998-3187
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNL0256074163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse