Provider Demographics
NPI:1750568481
Name:CANTILLON, DONNA LYNN (RN)
Entity type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:LYNN
Last Name:CANTILLON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 SOUTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:DE
Mailing Address - Zip Code:19977
Mailing Address - Country:US
Mailing Address - Phone:302-653-8585
Mailing Address - Fax:302-653-3149
Practice Address - Street 1:101 SOUTH LOCUST STREET
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:DE
Practice Address - Zip Code:19977
Practice Address - Country:US
Practice Address - Phone:302-653-8580
Practice Address - Fax:302-653-3413
Is Sole Proprietor?:No
Enumeration Date:2008-01-24
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELI0011474163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse