Provider Demographics
NPI:1518124775
Name:MACCARONE, DONNA JEANNE (RN, LMT)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:JEANNE
Last Name:MACCARONE
Suffix:
Gender:F
Credentials:RN, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 SPENCER ST
Mailing Address - Street 2:
Mailing Address - City:CANASTOTA
Mailing Address - State:NY
Mailing Address - Zip Code:13032-1160
Mailing Address - Country:US
Mailing Address - Phone:315-264-4621
Mailing Address - Fax:
Practice Address - Street 1:7118 MOUNT PLEASANT DR
Practice Address - Street 2:
Practice Address - City:CANASTOTA
Practice Address - State:NY
Practice Address - Zip Code:13032-4664
Practice Address - Country:US
Practice Address - Phone:315-697-5577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-16
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019523174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist