Provider Demographics
NPI:1396756599
Name:BLANEY, DONNA SUE (NON-AGENCY PROVIDER)
Entity type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:SUE
Last Name:BLANEY
Suffix:
Gender:F
Credentials:NON-AGENCY PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63321 S JOHNSON RD
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:OH
Mailing Address - Zip Code:43719-9703
Mailing Address - Country:US
Mailing Address - Phone:740-484-1180
Mailing Address - Fax:740-484-1180
Practice Address - Street 1:68205 COMMERCIAL DR
Practice Address - Street 2:APT. H2
Practice Address - City:BRIDGEPORT
Practice Address - State:OH
Practice Address - Zip Code:43912-1566
Practice Address - Country:US
Practice Address - Phone:740-633-0258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHDOES NOT APPLY3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2284880Medicaid