Provider Demographics
NPI:1003188780
Name:LUFKIN, DONNA MARIE (LPN)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:MARIE
Last Name:LUFKIN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:MARIE
Other - Last Name:BURGETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:2683 SOUTH PADDOCK DRIVE
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-8451
Mailing Address - Country:US
Mailing Address - Phone:907-631-3560
Mailing Address - Fax:
Practice Address - Street 1:2683 SOUTH PADDOCK DRIVE
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-8451
Practice Address - Country:US
Practice Address - Phone:907-631-3560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-27
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5145438164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse