Healthcare Provider Details

I. General information

NPI: 1639333008
Provider Name (Legal Business Name): GABRIELLE NICOLE DONOFRY-WOJCIK CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GABRIELLE NICOLE DONOFRY CRNA

II. Dates (important events)

Enumeration Date: 07/15/2008
Last Update Date: 07/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 S 11TH ST SUITE 3390
PHILADELPHIA PA
19107-4824
US

IV. Provider business mailing address

111 S 11TH ST SUITE 3390
PHILADELPHIA PA
19107-4824
US

V. Phone/Fax

Practice location:
  • Phone: 215-955-6161
  • Fax: 215-923-5507
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN330569L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN330569L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: