Provider Demographics
NPI:1356341374
Name:GISLESON, DONNA B (MSN, CRNP)
Entity type:Individual
Prefix:MS
First Name:DONNA
Middle Name:B
Last Name:GISLESON
Suffix:
Gender:F
Credentials:MSN, CRNP
Other - Prefix:MS
Other - First Name:DONNA
Other - Middle Name:
Other - Last Name:TODARO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, CRNP
Mailing Address - Street 1:1900 WATERDAM PLAZA DR BLDG 32ND
Mailing Address - Street 2:
Mailing Address - City:CANONSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15317-5442
Mailing Address - Country:US
Mailing Address - Phone:724-941-7490
Mailing Address - Fax:724-941-5231
Practice Address - Street 1:1900 WATERDAM PLAZA DR BLDG 32ND
Practice Address - Street 2:
Practice Address - City:CANONSBURG
Practice Address - State:PA
Practice Address - Zip Code:15317-5442
Practice Address - Country:US
Practice Address - Phone:724-941-7490
Practice Address - Fax:724-941-5231
Is Sole Proprietor?:No
Enumeration Date:2005-08-01
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAVP004870B363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP00049853Medicare PIN
PA022016Q17Medicare PIN