Provider Demographics
NPI:1447363858
Name:LEVY, DONNA RICHARD (FNP)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:RICHARD
Last Name:LEVY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1042 CAMELLIA BLVD
Mailing Address - Street 2:3203
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-6680
Mailing Address - Country:US
Mailing Address - Phone:337-356-5760
Mailing Address - Fax:
Practice Address - Street 1:524 S RYAN ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-5725
Practice Address - Country:US
Practice Address - Phone:337-491-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN04523 AP03113363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1532614Medicaid
LA5X353Medicare ID - Type Unspecified
LA1532614Medicaid