Provider Demographics
NPI:1952683187
Name:TIPTON, DONNA M (RN)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:M
Last Name:TIPTON
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 1:99 BUCKLEY RD
Mailing Address - Street 2:PO BOX 29
Mailing Address - City:WHITEHALL
Mailing Address - State:NY
Mailing Address - Zip Code:12887-3633
Mailing Address - Country:US
Mailing Address - Phone:518-499-0330
Mailing Address - Fax:518-499-1752
Practice Address - Street 1:99 BUCKLEY RD
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:NY
Practice Address - Zip Code:12887-3633
Practice Address - Country:US
Practice Address - Phone:518-499-0330
Practice Address - Fax:518-499-1752
Is Sole Proprietor?:No
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY328016-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse