Donnelly, Richard E
Donnelly, Richard E is an sole proprietor health care provider with primary practice located at 43 W. White Mountain Blvd , Lakeside AZ 85929-7002. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Surgical, which is considered as his primary health care specialty. Donnelly, Richard E can be contacted via phone (928) 367-4040.Contact Information
Primary practice address
43 W. White Mountain Blvd
Lakeside AZ 85929-7002
Phone: (928) 367-4040
Fax: (928) 367-4042
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Surgical | 363AS0400X | 1105 | Arizona |
| Physician Assistants & Advanced Practice Nursing Providers / Surgical | 363AS0400X | 10186 | Minnesota |
Profile Details
| NPI number | 1396729455 |
|---|---|
| LBN Legal business name | Donnelly, Richard E |
| Credentials | Physician's Assistant Certified (PA-C) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Dec 2nd, 2005 |
| Last updated | Feb 16th, 2011 - about 12 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1396729455 | NPPES |
| Arizona | Other | 86080015085259A253 | TRIWEST |
| Arizona | MEDICAID | 558930400 | TRIWEST |
| Arizona | MEDICAID | 342254 | TRIWEST |
| Arizona | Other | 970001299 | TRIWEST |
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