Individual
DONNA MARIE PROKOP-FETTIG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.-C
Contact information
Practice address
1201 SAM BASS RD, ROUND ROCK, TX 78681-4137
(512) 388-1861
(512) 388-0373
Mailing address
PO BOX 268945, OKLAHOMA CITY, OK 73126-8945
(512) 388-1861
(512) 388-0373
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA06103
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2028235-01
—
TX
05
—
2028235-02
—
TX
Enumeration date
12/18/2008
Last updated
09/14/2009
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