Provider Demographics
NPI:1730556044
Name:WALSWORTH, DONNA MARIE (RN, BSN)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:MARIE
Last Name:WALSWORTH
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 SOUTH CHURCH ST
Mailing Address - Street 2:P O BOX 194
Mailing Address - City:NUNDA
Mailing Address - State:NY
Mailing Address - Zip Code:14517
Mailing Address - Country:US
Mailing Address - Phone:585-468-5799
Mailing Address - Fax:585-658-7860
Practice Address - Street 1:27 LACKAWANNA AVE
Practice Address - Street 2:
Practice Address - City:MOUNT MORRIS
Practice Address - State:NY
Practice Address - Zip Code:14510-1001
Practice Address - Country:US
Practice Address - Phone:585-658-7811
Practice Address - Fax:585-658-7860
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-24
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY205901163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse