Provider Demographics
NPI:1376886804
Name:DELLOIACONO, DONNA MARIE (NP, PHD)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:MARIE
Last Name:DELLOIACONO
Suffix:
Gender:F
Credentials:NP, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 WEYFAIR PATH
Mailing Address - Street 2:
Mailing Address - City:SOUTH WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02190-2638
Mailing Address - Country:US
Mailing Address - Phone:781-331-7783
Mailing Address - Fax:781-340-3969
Practice Address - Street 1:42 WEYFAIR PATH
Practice Address - Street 2:
Practice Address - City:SOUTH WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190-2638
Practice Address - Country:US
Practice Address - Phone:781-331-7783
Practice Address - Fax:781-340-3969
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
MA151651363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAA00000Medicare UPIN