Active NPI
Eva Petkac Donnelly, RD/LD
- Renal Nutrition Registered Dietitian
- Canton, OH
National Provider Identifier
1740219146
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Renal Nutrition Registered Dietitian
- License
- 21
- Practice address
- 4689 Fulton Dr NW
Canton, OH 44718-2379 - Phone
- (330) 649-9400
- Fax
- (330) 649-8059
- NPI assigned
- Jun 30, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Renal Nutrition Registered Dietitian | 133VN1005X | 21 | OH | Primary |
Addresses
Primary practice location
4689 Fulton Dr NW
Canton, OH 44718-2379
Mailing address
4685 Fulton Dr NW
Canton, OH 44718-2379
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 21 | OH | MD | Renal Nutrition Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151625600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1740219146",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4685 FULTON DR NW",
"city": "CANTON",
"state": "OH",
"postal_code": "447182379"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4689 FULTON DR NW",
"city": "CANTON",
"state": "OH",
"postal_code": "447182379",
"telephone_number": "330-649-9400",
"fax_number": "330-649-8059"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DONNELLY",
"first_name": "EVA",
"middle_name": "PETKAC",
"name_prefix": "Ms.",
"credential": "RD/LD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-30",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "133VN1005X",
"taxonomy_group": "",
"desc": "Dietitian, Registered, Nutrition, Renal",
"state": "OH",
"license": "21",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Canton, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.