Provider Demographics
NPI:1184125056
Name:HARROLD, DONNA M
Entity type:Individual
Prefix:MS
First Name:DONNA
Middle Name:M
Last Name:HARROLD
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 1:16 WEDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01843-3668
Mailing Address - Country:US
Mailing Address - Phone:978-423-7829
Mailing Address - Fax:
Practice Address - Street 1:16 WEDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01843-3668
Practice Address - Country:US
Practice Address - Phone:978-423-7829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-26
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA20-2124792OtherHOME HEALTH AGENCY