Provider Demographics
NPI:1235153602
Name:WOOD SHOLBERG, DONNA L (MSN RN CS)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:L
Last Name:WOOD SHOLBERG
Suffix:
Gender:F
Credentials:MSN RN CS
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:L
Other - Last Name:WOOD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSN RN CS
Mailing Address - Street 1:280 CHESTNUT ST
Mailing Address - Street 2:2ND FL
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01199-1001
Mailing Address - Country:US
Mailing Address - Phone:413-794-5700
Mailing Address - Fax:
Practice Address - Street 1:42 WRIGHT ST
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:MA
Practice Address - Zip Code:01069-1156
Practice Address - Country:US
Practice Address - Phone:413-284-5285
Practice Address - Fax:413-284-5384
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA87456364SP0808X, 364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
N50531Medicare ID - Type Unspecified