Provider Demographics
NPI:1902526379
Name:HALL DONNAN, ATHENA (CD)
Entity Type:Individual
Prefix:
First Name:ATHENA
Middle Name:
Last Name:HALL DONNAN
Suffix:
Gender:F
Credentials:CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29487 ANSTED RD
Mailing Address - Street 2:
Mailing Address - City:EVANS MILLS
Mailing Address - State:NY
Mailing Address - Zip Code:13637-3248
Mailing Address - Country:US
Mailing Address - Phone:315-523-4886
Mailing Address - Fax:
Practice Address - Street 1:29487 ANSTED RD
Practice Address - Street 2:
Practice Address - City:EVANS MILLS
Practice Address - State:NY
Practice Address - Zip Code:13637-3248
Practice Address - Country:US
Practice Address - Phone:315-523-4886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY14322374J00000X
NY374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula