Provider Demographics
NPI:1780045575
Name:DONARUM, COURTNEY DALE (DNP, NP-C)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:DALE
Last Name:DONARUM
Suffix:
Gender:F
Credentials:DNP, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 LAKE ST
Mailing Address - Street 2:SUITE 202, 3RD FLOOR
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06052-1396
Mailing Address - Country:US
Mailing Address - Phone:860-348-4242
Mailing Address - Fax:
Practice Address - Street 1:ONE LAKE SREET
Practice Address - Street 2:SUITE 202, 3RD FLOOR
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06052-1396
Practice Address - Country:US
Practice Address - Phone:860-348-4242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-08
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6471363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily