Provider Demographics
NPI:1477035830
Name:DONNER, CAROL E
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:E
Last Name:DONNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8952 STATE ROUTE 289
Mailing Address - Street 2:
Mailing Address - City:ADAMS
Mailing Address - State:NY
Mailing Address - Zip Code:13605
Mailing Address - Country:US
Mailing Address - Phone:315-405-1435
Mailing Address - Fax:
Practice Address - Street 1:8952 STATE ROUTE 289
Practice Address - Street 2:
Practice Address - City:ADAMS
Practice Address - State:NY
Practice Address - Zip Code:13605
Practice Address - Country:US
Practice Address - Phone:315-405-1435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-03
Last Update Date:2018-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY754417-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse