Provider Demographics
NPI:1750550299
Name:MAITLAND, DONNA M (FNP)
Entity type:Individual
Prefix:MS
First Name:DONNA
Middle Name:M
Last Name:MAITLAND
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 WESTMINSTER LN
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07748-3528
Mailing Address - Country:US
Mailing Address - Phone:732-706-5770
Mailing Address - Fax:
Practice Address - Street 1:2200 HWY 66
Practice Address - Street 2:EXPRESSCARE, INSIDE SHOPRITE
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-4062
Practice Address - Country:US
Practice Address - Phone:732-775-6565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-28
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00153800363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily