Provider Demographics
NPI:1831341353
Name:CORMIER, DONNA MARIE (LMT)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:MARIE
Last Name:CORMIER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 LYRIC LN # 49
Mailing Address - Street 2:
Mailing Address - City:CENTER CONWAY
Mailing Address - State:NH
Mailing Address - Zip Code:03813-4142
Mailing Address - Country:US
Mailing Address - Phone:603-662-4150
Mailing Address - Fax:
Practice Address - Street 1:581 MAIN ST
Practice Address - Street 2:
Practice Address - City:FRYEBURG
Practice Address - State:ME
Practice Address - Zip Code:04037-1125
Practice Address - Country:US
Practice Address - Phone:603-662-4150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-15
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEME486844171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor