Provider Demographics
NPI:1073700282
Name:WILSON, DONIELLE K (ND)
Entity Type:Individual
Prefix:DR
First Name:DONIELLE
Middle Name:K
Last Name:WILSON
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 JUNE RD
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10918-1102
Mailing Address - Country:US
Mailing Address - Phone:845-729-0582
Mailing Address - Fax:845-469-9551
Practice Address - Street 1:1185 E PUTNAM AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CT
Practice Address - Zip Code:06878-1429
Practice Address - Country:US
Practice Address - Phone:845-729-0582
Practice Address - Fax:845-469-9551
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-02
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT246175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath