Provider Demographics
NPI:1730262056
Name:FLADD, DONNA M (NP)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:M
Last Name:FLADD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4701 MIDDLE RD
Mailing Address - Street 2:
Mailing Address - City:RUSHVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14544-9708
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:465 N MAIN ST
Practice Address - Street 2:JDK CENTER
Practice Address - City:PENN YAN
Practice Address - State:NY
Practice Address - Zip Code:14527-1069
Practice Address - Country:US
Practice Address - Phone:315-531-2400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF400778363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP98306Medicare UPIN