Provider Demographics
NPI:1306876792
Name:REKKERTH, DONNA J (NP)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:J
Last Name:REKKERTH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2365 CLINTON AVE S
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-2645
Mailing Address - Country:US
Mailing Address - Phone:585-758-5700
Mailing Address - Fax:585-758-1293
Practice Address - Street 1:2365 CLINTON AVE S
Practice Address - Street 2:SUITE 200
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-2645
Practice Address - Country:US
Practice Address - Phone:585-758-5700
Practice Address - Fax:585-758-1293
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2010-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF332617163WX0601X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0601XNursing Service ProvidersRegistered NurseOtorhinolaryngology & Head-Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP019332617OtherBLUE CHOICE
NYS90118Medicare UPIN