Provider Demographics
NPI:1942380753
Name:DONOHUE, LIANE T (FNP)
Entity Type:Individual
Prefix:MRS
First Name:LIANE
Middle Name:T
Last Name:DONOHUE
Suffix:
Gender:F
Credentials:FNP
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Mailing Address - Street 1:736 IRVING AVE 6 MEMORIAL
Mailing Address - Street 2:CROUSE HOSPITAL
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13031-1206
Mailing Address - Country:US
Mailing Address - Phone:315-470-7111
Mailing Address - Fax:315-470-5617
Practice Address - Street 1:736 IRVING AVE
Practice Address - Street 2:6 MEMORIAL
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1687
Practice Address - Country:US
Practice Address - Phone:315-470-7111
Practice Address - Fax:315-470-5617
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2014-12-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NYF333747363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCRA DD 3911Medicare ID - Type Unspecified
NYP76903Medicare UPIN