Provider Demographics
NPI:1962012096
Name:RODARTE, DONNA LEE (RN)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:LEE
Last Name:RODARTE
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:PO BOX 275
Mailing Address - Street 2:
Mailing Address - City:MAXWELL
Mailing Address - State:NM
Mailing Address - Zip Code:87728-0275
Mailing Address - Country:US
Mailing Address - Phone:575-375-2371
Mailing Address - Fax:
Practice Address - Street 1:4TH STREET & PARQUE AVE
Practice Address - Street 2:
Practice Address - City:MAXWELL
Practice Address - State:NM
Practice Address - Zip Code:87728
Practice Address - Country:US
Practice Address - Phone:575-375-2371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-04
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRN-87021163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool