Basic Information
| Provider Information | |||||||||
| NPI: | 1851337562 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOUSE | ||||||||
| FirstName: | DONNA | ||||||||
| MiddleName: | P. | ||||||||
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| Credential: | N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2550 NORTH HOLLYWOOD WAY | ||||||||
| Address2: | SUITE 209 | ||||||||
| City: | BURBANK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 915055019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8185570135 | ||||||||
| FaxNumber: | 8185571394 | ||||||||
| Practice Location | |||||||||
| Address1: | 869 NORTH CHERRY STREET | ||||||||
| Address2: | |||||||||
| City: | TULARE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932742287 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596853450 | ||||||||
| FaxNumber: | 5596853869 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | NP4835 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | RN202819 | 05 | CA | MEDICAID |