Provider Demographics
NPI:1588878987
Name:CUMMINGS, DONNA C (PA-C)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:C
Last Name:CUMMINGS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:C
Other - Last Name:NIX-OQUENDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:705 RILEY HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5109
Practice Address - Country:US
Practice Address - Phone:317-948-6328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10000751A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN10000751AOtherPHYSICIAN ASSISTANT CERT
IN000000561413OtherBCBS
INP00717110Medicare PIN
IN187610CMedicare UPIN