Healthcare Provider Details

I. General information

NPI: 1164458295
Provider Name (Legal Business Name): DONA DUNKIN-ALBA DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DONA RAE DUNKIN DO

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 05/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 STATE ROUTE 664 N
LOGAN OH
43138-9250
US

IV. Provider business mailing address

PO BOX 228
LOGAN OH
43138-0228
US

V. Phone/Fax

Practice location:
  • Phone: 740-385-0202
  • Fax: 740-385-0505
Mailing address:
  • Phone: 740-385-0202
  • Fax: 740-385-0505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101016681
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34-006481
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: