Provider Demographics
NPI:1043029069
Name:SUPRICE, DONEIGE TANIS (BSN, RN)
Entity type:Individual
Prefix:
First Name:DONEIGE
Middle Name:TANIS
Last Name:SUPRICE
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 STOUGHTON RD
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026-5232
Mailing Address - Country:US
Mailing Address - Phone:617-653-6402
Mailing Address - Fax:
Practice Address - Street 1:30 STOUGHTON RD
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-5232
Practice Address - Country:US
Practice Address - Phone:617-653-6402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-03
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN250478163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse