Individual
MRS. DONNA ANTONIA THEODORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3604 BUSH ST, RALEIGH, NC 27609-7511
(919) 876-7807
(919) 876-8823
Mailing address
3604 BUSH ST, RALEIGH, NC 27609-7511
(919) 876-7807
(919) 876-8823
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
104147
NC
Other
Enumeration date
06/28/2006
Last updated
07/08/2007
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