Healthcare Provider Details

I. General information

NPI: 1366401531
Provider Name (Legal Business Name): DONNA JEAN DONALDSON AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DONNA JEAN DONALDSON A.UD,

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 11/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 W FOREST AVE SUITE 212
FLAGSTAFF AZ
86001-1479
US

IV. Provider business mailing address

77 WEST FOREST AVE, SUITE 212
FLAGSTAFF AZ
86001
US

V. Phone/Fax

Practice location:
  • Phone: 928-773-2218
  • Fax: 928-773-2287
Mailing address:
  • Phone: 928-773-2218
  • Fax: 928-773-2287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number200200998
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number00457
License Number StateIA
# 3
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberDA5862
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number00757
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: