Provider Demographics
NPI:1033672969
Name:STACHOWICZ, DONNA KATHLEEN (DNP, NP-C, CEN)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:KATHLEEN
Last Name:STACHOWICZ
Suffix:
Gender:F
Credentials:DNP, NP-C, CEN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 RIVER ROCK RD
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91914-2429
Mailing Address - Country:US
Mailing Address - Phone:267-971-7976
Mailing Address - Fax:
Practice Address - Street 1:7675 MISSION VALLEY RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-4429
Practice Address - Country:US
Practice Address - Phone:619-876-4268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-08
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA649059163WE0003X
CA20897363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20897OtherBOARD OF NURSING - NP CERTIFICATE