Provider Demographics
NPI:1932474996
Name:MAYER, DONNA A (RN)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:A
Last Name:MAYER
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 1:18 MAGNOLIA ST
Mailing Address - Street 2:
Mailing Address - City:CENTRAL ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11722-4726
Mailing Address - Country:US
Mailing Address - Phone:631-234-3881
Mailing Address - Fax:
Practice Address - Street 1:18 MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:CENTRAL ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11722-4726
Practice Address - Country:US
Practice Address - Phone:631-234-3881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-09
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY501645163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse