Provider Demographics
NPI:1437226115
Name:KOZMINSKI, DONNA MAY (LPN)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:MAY
Last Name:KOZMINSKI
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4250 HAAG RD
Mailing Address - Street 2:
Mailing Address - City:EDEN
Mailing Address - State:NY
Mailing Address - Zip Code:14057-9729
Mailing Address - Country:US
Mailing Address - Phone:716-992-4413
Mailing Address - Fax:
Practice Address - Street 1:4250 HAAG RD
Practice Address - Street 2:
Practice Address - City:EDEN
Practice Address - State:NY
Practice Address - Zip Code:14057-9729
Practice Address - Country:US
Practice Address - Phone:716-992-4413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY077626-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02742987Medicaid