Provider Demographics
NPI:1508407180
Name:BRIGHAM, DONNA JO (FNP)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:JO
Last Name:BRIGHAM
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:JO
Other - Last Name:CROWNINGSHIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1051 CRAFT RD
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-1016
Mailing Address - Country:US
Mailing Address - Phone:607-257-1107
Mailing Address - Fax:607-257-0369
Practice Address - Street 1:1051 CRAFT RD
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1016
Practice Address - Country:US
Practice Address - Phone:607-257-1107
Practice Address - Fax:607-257-0369
Is Sole Proprietor?:No
Enumeration Date:2019-10-04
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF349007-01363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner