Provider Demographics
NPI:1912139775
Name:FORKER, DONNA M (RPA-C)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:M
Last Name:FORKER
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 JUNIPER ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-5345
Mailing Address - Country:US
Mailing Address - Phone:516-249-3924
Mailing Address - Fax:
Practice Address - Street 1:8 JUNIPER ST
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-5345
Practice Address - Country:US
Practice Address - Phone:516-249-3924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-12
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013222363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical