Provider Demographics
NPI:1639485261
Name:EASTHAM, DONNA SAUNDERS
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:SAUNDERS
Last Name:EASTHAM
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 1:246 MARCELLUS DRIVE
Mailing Address - Street 2:
Mailing Address - City:BEREA
Mailing Address - State:KY
Mailing Address - Zip Code:40403
Mailing Address - Country:US
Mailing Address - Phone:859-626-2107
Mailing Address - Fax:859-985-9401
Practice Address - Street 1:246 MARCELLUS DR
Practice Address - Street 2:
Practice Address - City:BEREA
Practice Address - State:KY
Practice Address - Zip Code:40403-2078
Practice Address - Country:US
Practice Address - Phone:859-626-2107
Practice Address - Fax:859-985-9401
Is Sole Proprietor?:No
Enumeration Date:2010-08-20
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY174400000X171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator