Provider Demographics
NPI:1669672028
Name:FIFIELD, DONNA LOUISE (LICENSED PRACTICAL N)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:LOUISE
Last Name:FIFIELD
Suffix:
Gender:F
Credentials:LICENSED PRACTICAL N
Other - Prefix:MS
Other - First Name:DONNA
Other - Middle Name:L
Other - Last Name:HART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:4664 RT. 31
Mailing Address - Street 2:
Mailing Address - City:CLAY
Mailing Address - State:NY
Mailing Address - Zip Code:13041-8629
Mailing Address - Country:US
Mailing Address - Phone:315-430-2337
Mailing Address - Fax:
Practice Address - Street 1:4664 RT. 31
Practice Address - Street 2:
Practice Address - City:CLAY
Practice Address - State:NY
Practice Address - Zip Code:13041-8629
Practice Address - Country:US
Practice Address - Phone:315-430-2337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-23
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY152487164W00000X
NY152487-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY152487-1OtherPROFESSIONAL NURSING LICENSE
NY02022948Medicaid