Provider Demographics
NPI:1902532559
Name:HART, DONNA MARCELENE
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:MARCELENE
Last Name:HART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 E TROPICANA AVE STE 162
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-6516
Mailing Address - Country:US
Mailing Address - Phone:702-478-8171
Mailing Address - Fax:
Practice Address - Street 1:1500 E TROPICANA AVE STE 162
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-6516
Practice Address - Country:US
Practice Address - Phone:702-478-8171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-26
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion