Provider Demographics
NPI:1538029780
Name:POULOSKY, DONNA
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:POULOSKY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1523 PONDEROSA LN
Mailing Address - Street 2:
Mailing Address - City:SOUTH SIOUX CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68776-5402
Mailing Address - Country:US
Mailing Address - Phone:712-212-4532
Mailing Address - Fax:
Practice Address - Street 1:1523 PONDEROSA LN
Practice Address - Street 2:
Practice Address - City:SOUTH SIOUX CITY
Practice Address - State:NE
Practice Address - Zip Code:68776-5402
Practice Address - Country:US
Practice Address - Phone:712-212-4532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-12
Last Update Date:2025-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty