Provider Demographics
NPI:1699076273
Name:WILMORE, DONNA (LPN)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:WILMORE
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 1:130 MEARNS AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:10928-1010
Mailing Address - Country:US
Mailing Address - Phone:912-272-6000
Mailing Address - Fax:
Practice Address - Street 1:99 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-6026
Practice Address - Country:US
Practice Address - Phone:845-357-4500
Practice Address - Fax:845-357-5039
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-12
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY287817164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse