Provider Demographics
NPI:1336692680
Name:MONGEAU, DONNA (CRNP)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:MONGEAU
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2112 HARRISBURG PIKE
Mailing Address - Street 2:SUITE 312
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-2644
Mailing Address - Country:US
Mailing Address - Phone:717-544-3022
Mailing Address - Fax:717-544-3021
Practice Address - Street 1:2112 HARRISBURG PIKE
Practice Address - Street 2:SUITE 312
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-2644
Practice Address - Country:US
Practice Address - Phone:717-544-3022
Practice Address - Fax:717-544-3021
Is Sole Proprietor?:No
Enumeration Date:2016-08-03
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PASP016338363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology