Provider Demographics
NPI:1942570270
Name:STOUT, DONNA KAY (RN BS)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:KAY
Last Name:STOUT
Suffix:
Gender:F
Credentials:RN BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:478 BURLINGHAM RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGBURG
Mailing Address - State:NY
Mailing Address - Zip Code:12721-5011
Mailing Address - Country:US
Mailing Address - Phone:845-733-5469
Mailing Address - Fax:
Practice Address - Street 1:141 UNION ST
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:NY
Practice Address - Zip Code:12549-1316
Practice Address - Country:US
Practice Address - Phone:845-457-2400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-03
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY280196-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse