Provider Demographics
NPI:1255568424
Name:HALLABUK, DONNA
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:HALLABUK
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 1:919 DUTCH MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:DUSHORE
Mailing Address - State:PA
Mailing Address - Zip Code:18614-8005
Mailing Address - Country:US
Mailing Address - Phone:570-928-8715
Mailing Address - Fax:
Practice Address - Street 1:919 DUTCH MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:DUSHORE
Practice Address - State:PA
Practice Address - Zip Code:18614-8005
Practice Address - Country:US
Practice Address - Phone:570-928-8715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-16
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY262765164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse