Provider Demographics
NPI:1760508527
Name:BYRON, DONNA DISTEFANO (RN)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:DISTEFANO
Last Name:BYRON
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 1:1903 W MAIN RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02842-7963
Mailing Address - Country:US
Mailing Address - Phone:401-847-8961
Mailing Address - Fax:
Practice Address - Street 1:21 CHAPEL ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02840-3255
Practice Address - Country:US
Practice Address - Phone:401-849-2101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI19801163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool