Provider Demographics
NPI:1215617659
Name:LAROCQUE, DONNA JEANNE (FNP)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:JEANNE
Last Name:LAROCQUE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2000
Mailing Address - Street 2:
Mailing Address - City:DANNEMORA
Mailing Address - State:NY
Mailing Address - Zip Code:12929-2000
Mailing Address - Country:US
Mailing Address - Phone:518-492-2511
Mailing Address - Fax:518-492-2503
Practice Address - Street 1:1156 STATE ROUTE 374
Practice Address - Street 2:
Practice Address - City:DANNEMORA
Practice Address - State:NY
Practice Address - Zip Code:12929
Practice Address - Country:US
Practice Address - Phone:518-492-2511
Practice Address - Fax:518-492-2503
Is Sole Proprietor?:No
Enumeration Date:2023-07-20
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY352323363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily