Individual
MS. CAROL DIANE DONNELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1515 HOLCOMBE BLVD, HOUSTON, TX 77030-4095
(713) 792-6161
Mailing address
PO BOX 4439, HOUSTON, TX 77210-4439
(713) 792-2991
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA04224
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8N9867
BCBSTX PROVIDER NUMBER
TX
Enumeration date
06/22/2006
Last updated
07/08/2007
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