Provider Demographics
NPI:1366762544
Name:LAGRANGE, DONNA (REGISTERED NURSE)
Entity type:Individual
Prefix:MS
First Name:DONNA
Middle Name:
Last Name:LAGRANGE
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84A CHURCH DR
Mailing Address - Street 2:
Mailing Address - City:MASTIC BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11951-1812
Mailing Address - Country:US
Mailing Address - Phone:631-281-2348
Mailing Address - Fax:
Practice Address - Street 1:84A CHURCH DR
Practice Address - Street 2:
Practice Address - City:MASTIC BEACH
Practice Address - State:NY
Practice Address - Zip Code:11951-1812
Practice Address - Country:US
Practice Address - Phone:631-281-2348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-10
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390702-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse