1811030828 NPI number — DONNA ANN GILLETTE ANP

Table of content: DONNA ANN GILLETTE ANP (NPI 1811030828)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811030828 NPI number — DONNA ANN GILLETTE ANP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GILLETTE
Provider First Name:
DONNA
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ANP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KOBUSZEWSKI
Provider Other First Name:
DONNA
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1811030828
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/28/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14 RICHLEE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAMILLUS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13031-1548
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ST. CAMILLUS HEALTH & REHABILITATION CENTER
Provider Second Line Business Practice Location Address:
813 FAY RD
Provider Business Practice Location Address City Name:
SYRACUSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-488-2951
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/15/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  F300939 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)