Provider Demographics
NPI:1699927467
Name:LEWIS, DONNA MAE (CNS)
Entity type:Individual
Prefix:MS
First Name:DONNA
Middle Name:MAE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6938 PALMER RD
Mailing Address - Street 2:
Mailing Address - City:ETNA
Mailing Address - State:OH
Mailing Address - Zip Code:43046-9002
Mailing Address - Country:US
Mailing Address - Phone:740-408-6329
Mailing Address - Fax:
Practice Address - Street 1:6938 PALMER RD
Practice Address - Street 2:
Practice Address - City:ETNA
Practice Address - State:OH
Practice Address - Zip Code:43046-9002
Practice Address - Country:US
Practice Address - Phone:740-408-6329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-10
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN 307328163W00000X
OHRN.307328364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1699927467Medicaid