Healthcare Provider Details

I. General information

NPI: 1871181867
Provider Name (Legal Business Name): DONNA LOUISE OBLACHINSKI REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2021
Last Update Date: 01/05/2021
Certification Date: 01/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CVS DR
WOONSOCKET RI
02895-6195
US

IV. Provider business mailing address

3916 N POTSDAM AVE # 2691
SIOUX FALLS SD
57104-7048
US

V. Phone/Fax

Practice location:
  • Phone: 800-995-2673
  • Fax:
Mailing address:
  • Phone: 970-409-9127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number758743
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: