Basic Information
Provider Information | |||||||||
NPI: | 1902816838 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HUSMANN | ||||||||
FirstName: | DONNA | ||||||||
MiddleName: | MARIE | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 700 PICKWICK DR | ||||||||
Address2: |   | ||||||||
City: | VESTAL | ||||||||
State: | NY | ||||||||
PostalCode: | 138503133 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6077854312 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 860 OLD VESTAL LANE | ||||||||
Address2: | VESTAL NURSING CENTER | ||||||||
City: | VESTAL | ||||||||
State: | NY | ||||||||
PostalCode: | 13850 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6077544105 | ||||||||
FaxNumber: | 6077485689 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/09/2006 | ||||||||
LastUpdateDate: | 03/23/2009 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0300X | 239463 | NY | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine |
No ID Information.