1295133031 NPI number — MRS. DONNA LEE NEWELL PMHCNS-BC

Table of content: MRS. DONNA LEE NEWELL PMHCNS-BC (NPI 1295133031)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295133031 NPI number — MRS. DONNA LEE NEWELL PMHCNS-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NEWELL
Provider First Name:
DONNA
Provider Middle Name:
LEE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PMHCNS-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COSTABILE
Provider Other First Name:
DONNA
Provider Other Middle Name:
LEE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1295133031
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/10/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
110 SOUTHLAKE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOOVER
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35244-3329
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-777-8184
Provider Business Mailing Address Fax Number:
205-978-7802

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 CENTURY PARK S
Provider Second Line Business Practice Location Address:
SUITE 206
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35226-3949
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-978-7800
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/10/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 364SP0809X , with the licence number:  1-031253 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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