Provider Demographics
NPI:1245885300
Name:CASALICCHIO, DONNA L
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:L
Last Name:CASALICCHIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3258 LOTZE LOOP
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-8546
Mailing Address - Country:US
Mailing Address - Phone:425-223-0279
Mailing Address - Fax:
Practice Address - Street 1:3258 LOTZE LOOP
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815-8546
Practice Address - Country:US
Practice Address - Phone:422-223-0279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-06
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide