Healthcare Provider Details

I. General information

NPI: 1871612499
Provider Name (Legal Business Name): MS. DONNA JEAN HOLSHUER III
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3655 CHARLES ST
ROSEVILLE OH
43777-9732
US

IV. Provider business mailing address

3655 CHARLES ST
ROSEVILLE OH
43777-9732
US

V. Phone/Fax

Practice location:
  • Phone: 740-849-3008
  • Fax:
Mailing address:
  • Phone: 740-849-3008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number2251254
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: