Provider Demographics
NPI:1811030828
Name:GILLETTE, DONNA ANN (ANP)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:ANN
Last Name:GILLETTE
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:ANN
Other - Last Name:KOBUSZEWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14 RICHLEE DR
Mailing Address - Street 2:
Mailing Address - City:CAMILLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13031-1548
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:ST. CAMILLUS HEALTH & REHABILITATION CENTER
Practice Address - Street 2:813 FAY RD
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13219
Practice Address - Country:US
Practice Address - Phone:315-488-2951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF300939363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
S22246Medicare UPIN
BB5395Medicare PIN