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General NPI Number Information
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NPI Number | 1063725547
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Entity Type | Individual
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Provider Name | JENNIFER L. DONNELLY DFNP, APRN, NP-BC
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Gender | Female
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Dates
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Enumeration Date | 07/26/2010
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Last Update Date | 11/13/2024
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Provider Practice Location Address
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Address Line | 602 SW 38TH ST
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City | LAWTON
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State | OK
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Zip | 73505-6912
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Country | US
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Telephone | 580-248-5780
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Fax |
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Provider Business Mailing Address
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Address Line | 1207 MAPLE AVE
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City | ELGIN
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State | OK
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Zip | 73538-9003
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Country | US
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Telephone | 580-458-2373
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 81703
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 81703
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License Number State | OK
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