Provider Demographics
NPI:1629549381
Name:GRESIO, DONNA MARIE (LPN)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:MARIE
Last Name:GRESIO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:DONNA
Other - Middle Name:GRESIO
Other - Last Name:KERSHAW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:353 PATCHOGUE YAPHANK RD
Mailing Address - Street 2:
Mailing Address - City:EAST PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-4826
Mailing Address - Country:US
Mailing Address - Phone:631-205-4188
Mailing Address - Fax:
Practice Address - Street 1:353 PATCHOGUE YAPHANK RD
Practice Address - Street 2:
Practice Address - City:EAST PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-4826
Practice Address - Country:US
Practice Address - Phone:631-205-4188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-06
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251563164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse