Provider Demographics
NPI:1912604315
Name:DEMOTT, DONNA LEE (PA-C)
Entity type:Individual
Prefix:MS
First Name:DONNA
Middle Name:LEE
Last Name:DEMOTT
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:43017 LANCELOT DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-1917
Mailing Address - Country:US
Mailing Address - Phone:517-518-2862
Mailing Address - Fax:
Practice Address - Street 1:1711 MONROE ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2914
Practice Address - Country:US
Practice Address - Phone:313-562-9100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-15
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5315236874363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant