Provider Demographics
NPI:1396744264
Name:DELINE, DONNA MICHELLE (LPN)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:MICHELLE
Last Name:DELINE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 S MEADOW ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-3221
Mailing Address - Country:US
Mailing Address - Phone:315-786-1428
Mailing Address - Fax:
Practice Address - Street 1:211 S MEADOW ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-3221
Practice Address - Country:US
Practice Address - Phone:315-786-1428
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY236536-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse