Provider Demographics
NPI:1487275020
Name:DAVID, DONALD JOSEPH (LPN)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:JOSEPH
Last Name:DAVID
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3205 NE 25TH LANE
Mailing Address - Street 2:
Mailing Address - City:CARNATION
Mailing Address - State:WA
Mailing Address - Zip Code:98014
Mailing Address - Country:US
Mailing Address - Phone:425-214-2481
Mailing Address - Fax:
Practice Address - Street 1:32205 NE 25TH LN
Practice Address - Street 2:
Practice Address - City:CARNATION
Practice Address - State:WA
Practice Address - Zip Code:98014-6112
Practice Address - Country:US
Practice Address - Phone:425-214-2481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-06
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60483408164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse