Provider Demographics
NPI:1467009910
Name:PRINCIPATO, DONALD S
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:S
Last Name:PRINCIPATO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 S HIGHTOWER CT
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-6977
Mailing Address - Country:US
Mailing Address - Phone:870-430-5379
Mailing Address - Fax:
Practice Address - Street 1:48 S HIGHTOWER CT
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-6977
Practice Address - Country:US
Practice Address - Phone:870-430-5379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-20
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider