Provider Demographics
NPI:1568420230
Name:TEW, DONNA JEAN (ARNP)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:JEAN
Last Name:TEW
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:JEAN
Other - Last Name:TEW-VITULLO, METCALF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:P.O. BOX 30
Mailing Address - Street 2:
Mailing Address - City:GREAT BARRINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01230
Mailing Address - Country:US
Mailing Address - Phone:413-528-9311
Mailing Address - Fax:413-644-0274
Practice Address - Street 1:71 HOSPITAL AVENUE
Practice Address - Street 2:
Practice Address - City:ADAMS
Practice Address - State:MA
Practice Address - Zip Code:01247
Practice Address - Country:US
Practice Address - Phone:413-664-4088
Practice Address - Fax:413-663-6405
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9278260363L00000X
FLARNP9278260363L00000X
AZ082117363L00000X
MA149036363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110119136AMedicaid
P31763Medicare UPIN