Healthcare Provider Details

I. General information

NPI: 1134206113
Provider Name (Legal Business Name): DONNA LEE JUDKINS WORKMAN CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DONNA J WORKMAN CNP

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 12/07/2024
Certification Date: 12/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 LIBERTY ST
CONNEAUT OH
44030-2625
US

IV. Provider business mailing address

530 LIBERTY ST
CONNEAUT OH
44030-2625
US

V. Phone/Fax

Practice location:
  • Phone: 440-228-0506
  • Fax: 440-593-5799
Mailing address:
  • Phone: 440-228-0506
  • Fax: 440-593-5799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number245284
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN245284;CTPNP08104
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number08104
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: