Provider Demographics
NPI:1316318454
Name:MARCENGILL, DONNA GIBSON (FNP-C)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:GIBSON
Last Name:MARCENGILL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 100174
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29202-3174
Mailing Address - Country:US
Mailing Address - Phone:864-512-5955
Mailing Address - Fax:864-512-5957
Practice Address - Street 1:2000 E GREENVILLE ST STE 2000
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-1720
Practice Address - Country:US
Practice Address - Phone:864-512-5955
Practice Address - Fax:864-512-5957
Is Sole Proprietor?:No
Enumeration Date:2015-10-15
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19783363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP3548Medicaid
SCNP3548Medicaid