Healthcare Provider Details

I. General information

NPI: 1659003523
Provider Name (Legal Business Name): CAROLANN DONOROVICH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2022
Last Update Date: 06/28/2022
Certification Date: 06/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 HOOVER PKWY
LOCKPORT NY
14094-5737
US

IV. Provider business mailing address

11 HOOVER PKWY
LOCKPORT NY
14094-5737
US

V. Phone/Fax

Practice location:
  • Phone: 716-444-4780
  • Fax:
Mailing address:
  • Phone: 716-444-4780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number402062
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: