Provider Demographics
NPI:1417776444
Name:DONATELLI, NICOLE STEPHANIE LEVIN (RN, PHN)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:STEPHANIE LEVIN
Last Name:DONATELLI
Suffix:
Gender:F
Credentials:RN, PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4444 FALLSBRAE RD
Mailing Address - Street 2:
Mailing Address - City:FALLBROOK
Mailing Address - State:CA
Mailing Address - Zip Code:92028-8907
Mailing Address - Country:US
Mailing Address - Phone:619-341-2303
Mailing Address - Fax:
Practice Address - Street 1:4444 FALLSBRAE RD
Practice Address - Street 2:
Practice Address - City:FALLBROOK
Practice Address - State:CA
Practice Address - Zip Code:92028-8907
Practice Address - Country:US
Practice Address - Phone:619-341-2303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA793329163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health