Provider Demographics
NPI:1114478211
Name:DONDERO, DENA LAURICE (RN)
Entity Type:Individual
Prefix:
First Name:DENA
Middle Name:LAURICE
Last Name:DONDERO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:DENA
Other - Middle Name:LAURICE
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:52 TU SU LANE
Mailing Address - Street 2:
Mailing Address - City:BISHOP
Mailing Address - State:CA
Mailing Address - Zip Code:93514-8058
Mailing Address - Country:US
Mailing Address - Phone:760-873-8464
Mailing Address - Fax:760-873-3935
Practice Address - Street 1:52 TU SU LANE
Practice Address - Street 2:
Practice Address - City:BISHOP
Practice Address - State:CA
Practice Address - Zip Code:93514-8058
Practice Address - Country:US
Practice Address - Phone:760-873-8464
Practice Address - Fax:760-873-3935
Is Sole Proprietor?:No
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA805340163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice