Provider Demographics
NPI:1891093274
Name:ANDERSON, DONNA M (BSRN, CDOE)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:M
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:BSRN, CDOE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 KING ST
Mailing Address - Street 2:
Mailing Address - City:UXBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01569-2120
Mailing Address - Country:US
Mailing Address - Phone:508-278-6182
Mailing Address - Fax:
Practice Address - Street 1:186 CASS AVE
Practice Address - Street 2:
Practice Address - City:WOONSOCKET
Practice Address - State:RI
Practice Address - Zip Code:02895-4712
Practice Address - Country:US
Practice Address - Phone:401-769-9355
Practice Address - Fax:401-765-1721
Is Sole Proprietor?:No
Enumeration Date:2011-03-08
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRN26015163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator