Provider Demographics
NPI:1962885814
Name:BAIR, DONNA (NP)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:BAIR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9000 N MAIN ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ENGLEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45415-1180
Mailing Address - Country:US
Mailing Address - Phone:937-832-2425
Mailing Address - Fax:937-832-8495
Practice Address - Street 1:9000 N MAIN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:ENGLEWOOD
Practice Address - State:OH
Practice Address - Zip Code:45415-1180
Practice Address - Country:US
Practice Address - Phone:937-832-2425
Practice Address - Fax:937-832-8495
Is Sole Proprietor?:No
Enumeration Date:2015-07-09
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.17457-NP363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0137996Medicaid
OH0137996Medicaid