Provider Demographics
NPI:1518161991
Name:VAUPEL, DONNA LYNN (RN)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:LYNN
Last Name:VAUPEL
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 1:69 WARREN AVE.
Mailing Address - Street 2:
Mailing Address - City:LK. RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-1937
Mailing Address - Country:US
Mailing Address - Phone:631-846-3236
Mailing Address - Fax:
Practice Address - Street 1:69 WARREN AVE
Practice Address - Street 2:
Practice Address - City:LK RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-1937
Practice Address - Country:US
Practice Address - Phone:631-846-3236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY349701163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01130845Medicaid