Healthcare Provider Details

I. General information

NPI: 1497667141
Provider Name (Legal Business Name): DONQUET PERNSLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 SPENCER AVE
LEOLA PA
17540-1967
US

IV. Provider business mailing address

209 SPENCER AVE
LEOLA PA
17540-1967
US

V. Phone/Fax

Practice location:
  • Phone: 223-264-6143
  • Fax:
Mailing address:
  • Phone: 223-264-6143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number27588258
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: