Provider Demographics
NPI:1689844086
Name:WILEY, DONNA MARIE (LPN)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:MARIE
Last Name:WILEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:DONNA
Other - Middle Name:MARIE
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:34971 APPLE WOOD RD
Mailing Address - Street 2:
Mailing Address - City:LA FARGEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13656-3205
Mailing Address - Country:US
Mailing Address - Phone:315-658-0716
Mailing Address - Fax:315-658-0716
Practice Address - Street 1:34971 APPLE WOOD RD
Practice Address - Street 2:
Practice Address - City:LA FARGEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13656-3205
Practice Address - Country:US
Practice Address - Phone:315-658-0716
Practice Address - Fax:315-658-0716
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY253390-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse