Provider Demographics
NPI:1184669632
Name:SCANLON, DONNA L (RN)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:L
Last Name:SCANLON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:281 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06118-1883
Mailing Address - Country:US
Mailing Address - Phone:860-569-5900
Mailing Address - Fax:860-895-2328
Practice Address - Street 1:281 MAIN STREET
Practice Address - Street 2:
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06118-1883
Practice Address - Country:US
Practice Address - Phone:860-569-5900
Practice Address - Fax:860-895-2328
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTE33004163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse