MEDICARE: LORRAINE COZETTE DONNER RN, MSN, PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	15434-NP	OH

General Provider Information

NPI Number	:	1952722407
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORRAINE COZETTE DONNER RN, MSN, PMHNP-BC

Provider Business Mailing Address
First Line	:	33280 ELECTRIC BLVD
Second Line	:
City	:	AVON LAKE
State	:	OH
Zip	:	44012-1365
Country	:	US
Telephone Number	:	224-532-0753
Fax Number	:

Provider Business Practice Location Address
First Line	:	9500 EUCLID AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44195-3465
Country	:	US
Telephone Number	:	216-444-2200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/01/2014
Last Update Date	:	01/22/2014

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