Provider Demographics
NPI:1841545407
Name:DALFONSO, DONNA MARIE (RN)
Entity type:Individual
Prefix:MS
First Name:DONNA
Middle Name:MARIE
Last Name:DALFONSO
Suffix:
Gender:F
Credentials:RN
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Mailing Address - Street 1:2 EASTGATE AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MONESSEN
Mailing Address - State:PA
Mailing Address - Zip Code:15062-1389
Mailing Address - Country:US
Mailing Address - Phone:724-684-6489
Mailing Address - Fax:724-684-7116
Practice Address - Street 1:2 EASTGATE AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:MONESSEN
Practice Address - State:PA
Practice Address - Zip Code:15062-1389
Practice Address - Country:US
Practice Address - Phone:724-684-6489
Practice Address - Fax:724-684-7116
Is Sole Proprietor?:No
Enumeration Date:2012-07-19
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PARN259480L163WA0400X, 163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARN259480LOtherLICENSE