Provider Demographics
NPI:1811970122
Name:MINKIEWICZ, DONNA (CRNA)
Entity type:Individual
Prefix:MS
First Name:DONNA
Middle Name:
Last Name:MINKIEWICZ
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 CREAMERY LN
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-3137
Mailing Address - Country:US
Mailing Address - Phone:410-819-0710
Mailing Address - Fax:410-819-0712
Practice Address - Street 1:7402 YORK RD
Practice Address - Street 2:SUITE 101
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7532
Practice Address - Country:US
Practice Address - Phone:410-819-0710
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR032788207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG628Medicare ID - Type Unspecified
MDR82224Medicare UPIN