Provider Demographics
NPI:1053020149
Name:DARDEN, DONZETTA
Entity type:Individual
Prefix:
First Name:DONZETTA
Middle Name:
Last Name:DARDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5437 MILLBROOK RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44146-1651
Mailing Address - Country:US
Mailing Address - Phone:216-832-5530
Mailing Address - Fax:
Practice Address - Street 1:5437 MILLBROOK RD
Practice Address - Street 2:
Practice Address - City:BEDFORD HTS
Practice Address - State:OH
Practice Address - Zip Code:44146-1651
Practice Address - Country:US
Practice Address - Phone:216-832-5530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-17
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH79214370Medicaid