Healthcare Provider Details

I. General information

NPI: 1114141538
Provider Name (Legal Business Name): DONNA M MARSELLA I CNM, CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DONNA MARSELLA CNM, CFNP

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

396 BROADWAY
KINGSTON NY
12401
US

IV. Provider business mailing address

PO BOX 175
GLENFORD NY
12433-0175
US

V. Phone/Fax

Practice location:
  • Phone: 845-331-3131
  • Fax:
Mailing address:
  • Phone: 845-657-6292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF332166-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number000472-1
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License Number243401
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: