Provider Demographics
NPI:1134157449
Name:DESANTIS, DONNA (NP)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:DESANTIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:548 KINGS RD
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-4647
Mailing Address - Country:US
Mailing Address - Phone:215-499-1477
Mailing Address - Fax:
Practice Address - Street 1:548 KINGS RD
Practice Address - Street 2:
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-4647
Practice Address - Country:US
Practice Address - Phone:215-499-1477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN215153L163WG0000X
PAUP005471B363LF0000X
NJ26NN09176000363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily