Provider Demographics
NPI:1609122746
Name:MASTIN, DONNA (RN)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:MASTIN
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 1:5 6TH STREET
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NY
Mailing Address - Zip Code:13316
Mailing Address - Country:US
Mailing Address - Phone:315-264-0974
Mailing Address - Fax:315-245-1737
Practice Address - Street 1:5 6TH STREET
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NY
Practice Address - Zip Code:13316
Practice Address - Country:US
Practice Address - Phone:315-264-0974
Practice Address - Fax:315-245-1737
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-26
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY618263-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse