Provider Demographics
NPI:1053587220
Name:HARTMANN, DONNA L (LPN)
Entity type:Individual
Prefix:MISS
First Name:DONNA
Middle Name:L
Last Name:HARTMANN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 ZENITH RD
Mailing Address - Street 2:
Mailing Address - City:ROCKY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11778-8843
Mailing Address - Country:US
Mailing Address - Phone:631-849-2861
Mailing Address - Fax:
Practice Address - Street 1:14 ZENITH RD
Practice Address - Street 2:
Practice Address - City:ROCKY POINT
Practice Address - State:NY
Practice Address - Zip Code:11778-8843
Practice Address - Country:US
Practice Address - Phone:631-849-2861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2709851164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02908905Medicaid