Provider Demographics
NPI:1629144415
Name:HILL, DONNA M (REGISTERED NURSE)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:M
Last Name:HILL
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 MONTGOMERY ST
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-3410
Mailing Address - Country:US
Mailing Address - Phone:631-894-6660
Mailing Address - Fax:
Practice Address - Street 1:43 MONTGOMERY ST
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-3410
Practice Address - Country:US
Practice Address - Phone:631-894-6660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-26
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY285465-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY285465-1Medicaid
NY02798025Medicare ID - Type UnspecifiedLICENSED PRACTICAL NURSE