Provider Demographics
NPI:1699795310
Name:ALLEN, DONNA WIGGS (NP)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:WIGGS
Last Name:ALLEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 14145
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27620-4145
Mailing Address - Country:US
Mailing Address - Phone:919-231-6132
Mailing Address - Fax:919-231-6276
Practice Address - Street 1:3000 NEW BERN AVE
Practice Address - Street 2:SUITE 1200
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1231
Practice Address - Country:US
Practice Address - Phone:919-231-6132
Practice Address - Fax:919-231-6276
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC900393363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2809096Medicare ID - Type Unspecified