Provider Demographics
NPI:1174286397
Name:BRAULT, DONNA MARIE
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:MARIE
Last Name:BRAULT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 EAGLE WAY
Mailing Address - Street 2:
Mailing Address - City:WEST CHAZY
Mailing Address - State:NY
Mailing Address - Zip Code:12992-2562
Mailing Address - Country:US
Mailing Address - Phone:518-324-2520
Mailing Address - Fax:518-324-3695
Practice Address - Street 1:37 EAGLE WAY
Practice Address - Street 2:
Practice Address - City:WEST CHAZY
Practice Address - State:NY
Practice Address - Zip Code:12992-2562
Practice Address - Country:US
Practice Address - Phone:518-324-2520
Practice Address - Fax:518-324-3695
Is Sole Proprietor?:No
Enumeration Date:2021-10-14
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY349682163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool