Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | APRN00484 | RI |
NPI | 1043409790 |
---|---|
Provider Name | Donna Marie Rondeau-Marzullo |
First Address | Providence, RI 02903-4626 |
Second Address | Riverside, RI 02915-2232 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2007 |
Last Update Date | 19/06/2019 |