Provider Demographics
NPI:1053400697
Name:KUZMISKI, DONNA MARY (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:MARY
Last Name:KUZMISKI
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5319 N EDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:HEBER CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84032-5566
Mailing Address - Country:US
Mailing Address - Phone:801-828-8094
Mailing Address - Fax:
Practice Address - Street 1:SOUTHSIDE HOSPITAL
Practice Address - Street 2:301 E MAIN ST
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706
Practice Address - Country:US
Practice Address - Phone:631-968-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5951647-1206363AS0400X
NY005542-1363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical