Healthcare Provider Details

I. General information

NPI: 1356858724
Provider Name (Legal Business Name): DONNA GOKEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2018
Last Update Date: 01/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 COMMERCE LN
CANTON NY
13617-3739
US

IV. Provider business mailing address

501 TRACY RD
LISBON NY
13658-3191
US

V. Phone/Fax

Practice location:
  • Phone: 315-386-8191
  • Fax: 315-386-1410
Mailing address:
  • Phone: 315-386-2757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number342454
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: