Provider Demographics
NPI:1245573781
Name:BANDILLA, DONNA LEE (RN-BC)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:LEE
Last Name:BANDILLA
Suffix:
Gender:F
Credentials:RN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 METHUEN ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01840-1700
Mailing Address - Country:US
Mailing Address - Phone:978-291-2335
Mailing Address - Fax:978-687-1627
Practice Address - Street 1:12 METHUEN ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01840-1700
Practice Address - Country:US
Practice Address - Phone:978-291-2335
Practice Address - Fax:978-687-1627
Is Sole Proprietor?:No
Enumeration Date:2013-04-03
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA111295163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult