Provider Demographics
NPI:1043409790
Name:RONDEAU-MARZULLO, DONNA MARIE (NP)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:MARIE
Last Name:RONDEAU-MARZULLO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 ELM ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4626
Mailing Address - Country:US
Mailing Address - Phone:877-771-7401
Mailing Address - Fax:401-784-4902
Practice Address - Street 1:375 WAMPANOAG TRL
Practice Address - Street 2:SUITE 102
Practice Address - City:RIVERSIDE
Practice Address - State:RI
Practice Address - Zip Code:02915-2232
Practice Address - Country:US
Practice Address - Phone:401-649-4010
Practice Address - Fax:401-649-4011
Is Sole Proprietor?:No
Enumeration Date:2007-10-18
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN00484363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology