Provider Demographics
NPI:1457451213
Name:WALK, DONNA (CRNP)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:WALK
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:
Other - Last Name:RATUSHNY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17 CHERRY LN
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN TOP
Mailing Address - State:PA
Mailing Address - Zip Code:18707-1505
Mailing Address - Country:US
Mailing Address - Phone:570-403-1217
Mailing Address - Fax:
Practice Address - Street 1:545 N RIVER ST
Practice Address - Street 2:SUITE 130
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-2600
Practice Address - Country:US
Practice Address - Phone:570-270-4455
Practice Address - Fax:570-270-4884
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATP004183B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily