Basic Information
Provider Information | |||||||||
NPI: | 1609394584 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | DONARUMA | ||||||||
FirstName: | CRISTINE | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | FNP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 40 MANSFIELD AVE | ||||||||
Address2: |   | ||||||||
City: | WILLIMANTIC | ||||||||
State: | CT | ||||||||
PostalCode: | 062262018 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8604566297 | ||||||||
FaxNumber: | 8604561293 | ||||||||
Practice Location | |||||||||
Address1: | 202 POMFRET ST | ||||||||
Address2: |   | ||||||||
City: | PUTNAM | ||||||||
State: | CT | ||||||||
PostalCode: | 06260 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8609637917 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/31/2017 | ||||||||
LastUpdateDate: | 02/28/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 02/28/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WH0200X | RN2313411 | MA | N |   | Nursing Service Providers | Registered Nurse | Home Health | 363LF0000X | 7635 | CT | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.