Provider Demographics
NPI:1518720853
Name:WILLET, DONNETTA N,G (LPN)
Entity Type:Individual
Prefix:
First Name:DONNETTA
Middle Name:N,G
Last Name:WILLET
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 PARKSIDE CT
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-1050
Mailing Address - Country:US
Mailing Address - Phone:716-400-6273
Mailing Address - Fax:
Practice Address - Street 1:3 REES ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14213-1056
Practice Address - Country:US
Practice Address - Phone:716-884-3445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY338594164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse