Provider Demographics
NPI:1043520604
Name:DONNA CIVARDI RNFA, APRN, FNP-BC, LLC
Entity type:Organization
Organization Name:DONNA CIVARDI RNFA, APRN, FNP-BC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CIVARDI
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, FNP-BC
Authorized Official - Phone:860-383-2024
Mailing Address - Street 1:18 ONECO ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-3440
Mailing Address - Country:US
Mailing Address - Phone:860-383-2024
Mailing Address - Fax:
Practice Address - Street 1:18 ONECO ST
Practice Address - Street 2:SUITE 2
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-3440
Practice Address - Country:US
Practice Address - Phone:860-383-2024
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004438261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care