Provider Demographics
NPI:1912969908
Name:MISSONIS, DONNAMARIE A (CRNA)
Entity Type:Individual
Prefix:
First Name:DONNAMARIE
Middle Name:A
Last Name:MISSONIS
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:PO BOX 390
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18501
Mailing Address - Country:US
Mailing Address - Phone:570-346-7797
Mailing Address - Fax:570-342-9802
Practice Address - Street 1:509 N BROAD ST
Practice Address - Street 2:3RD FLOOR UNDERWOOD MEMORIAL HOSPITAL
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096
Practice Address - Country:US
Practice Address - Phone:856-845-0100
Practice Address - Fax:856-853-9334
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR03760300367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ009434Medicare ID - Type Unspecified