Provider Demographics
NPI:1831230119
Name:CIVARDI, DONNA M (RNFA, APRN, FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:M
Last Name:CIVARDI
Suffix:
Gender:F
Credentials:RNFA, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 W TOWN ST
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-2130
Mailing Address - Country:US
Mailing Address - Phone:860-383-2024
Mailing Address - Fax:860-373-2457
Practice Address - Street 1:223 W TOWN ST
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-2130
Practice Address - Country:US
Practice Address - Phone:860-383-2024
Practice Address - Fax:860-373-2457
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTE56768163WR0006X
CT004438363LF0000X, 363LP2300X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner