Provider Demographics
NPI:1669996732
Name:PRINCIPIO, DONNA M (LPN)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:M
Last Name:PRINCIPIO
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 1:2535 BREWER RD
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:NY
Mailing Address - Zip Code:13165-9592
Mailing Address - Country:US
Mailing Address - Phone:315-651-3390
Mailing Address - Fax:
Practice Address - Street 1:9053 STATE ROUTE 53
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:NY
Practice Address - Zip Code:14810-8008
Practice Address - Country:US
Practice Address - Phone:315-651-3160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY321372164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse