Provider Demographics
NPI:1457671836
Name:CRAFT-HATESAUL, DONNA (RN)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:CRAFT-HATESAUL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:728 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-3450
Mailing Address - Country:US
Mailing Address - Phone:845-514-2410
Mailing Address - Fax:845-514-2820
Practice Address - Street 1:728 BROADWAY
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-3450
Practice Address - Country:US
Practice Address - Phone:845-514-2410
Practice Address - Fax:845-514-2820
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-08
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY342846164W00000X
NY342846-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse