Healthcare Provider Details

I. General information

NPI: 1508590506
Provider Name (Legal Business Name): DONNA MARIE WHITESELL LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DONNA MARIE WHITESELL LPN

II. Dates (important events)

Enumeration Date: 07/14/2022
Last Update Date: 07/14/2022
Certification Date: 07/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 PRUSHNOK DRIVE
PUNXSUTAWNEY PA
15767
US

IV. Provider business mailing address

793 OLD ROUTE 119 HWY NORTH
INDIANA PA
15701
US

V. Phone/Fax

Practice location:
  • Phone: 814-938-4444
  • Fax:
Mailing address:
  • Phone: 724-465-5576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN254593L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: