Provider Demographics
NPI:1902809452
Name:DONAHUE, MARTHA ULYSSA (MSN, FNP)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:ULYSSA
Last Name:DONAHUE
Suffix:
Gender:F
Credentials:MSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 EOFF ST
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-3805
Mailing Address - Country:US
Mailing Address - Phone:304-234-3580
Mailing Address - Fax:304-234-3596
Practice Address - Street 1:2121 EOFF ST
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-3805
Practice Address - Country:US
Practice Address - Phone:304-234-3580
Practice Address - Fax:304-234-3596
Is Sole Proprietor?:No
Enumeration Date:2005-05-28
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2005000034-22363LF0000X
WV44795363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001722461OtherBCBS
WV3810004800Medicaid
WV3810004800Medicaid
Q39620Medicare UPIN
WVSMNP17887Medicare PIN
WVSMNP17881Medicare PIN