Provider Demographics
NPI:1114141538
Name:MARSELLA, DONNA M I (CNM, CFNP)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:M
Last Name:MARSELLA
Suffix:I
Gender:F
Credentials:CNM, CFNP
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:
Other - Last Name:MARSELLA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CNM, CFNP
Mailing Address - Street 1:PO BOX 175
Mailing Address - Street 2:
Mailing Address - City:GLENFORD
Mailing Address - State:NY
Mailing Address - Zip Code:12433-0175
Mailing Address - Country:US
Mailing Address - Phone:845-657-6292
Mailing Address - Fax:
Practice Address - Street 1:396 BROADWAY
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401
Practice Address - Country:US
Practice Address - Phone:845-331-3131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000472-1367A00000X
NYF332166-1363LF0000X
NY243401163WX0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Not Answered363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Not Answered163WX0003XNursing Service ProvidersRegistered NurseObstetric, Inpatient