Provider Demographics
NPI:1871552836
Name:GERRY, DONNA L (NP)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:L
Last Name:GERRY
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 1:126 UNION ST
Mailing Address - Street 2:
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-1207
Mailing Address - Country:US
Mailing Address - Phone:508-460-3872
Mailing Address - Fax:508-357-4150
Practice Address - Street 1:126 UNION ST
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-1207
Practice Address - Country:US
Practice Address - Phone:508-460-3872
Practice Address - Fax:508-357-4150
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA171238363L00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Not Answered363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAA50800OtherHARVARD PILGRIM
MA0380831Medicaid
MANP1738OtherBLUE CROSS
MANP1738Medicare ID - Type Unspecified
MANP1738OtherBLUE CROSS