MEDICARE: MS. DENISE ELIZABETH DONATELLI RN 219365

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN219365	OH
2	163WG0000X	General Practice Registered Nurse	RN219365	OH

General Provider Information

NPI Number	:	1659521813
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DENISE ELIZABETH DONATELLI RN 219365

Provider Business Mailing Address
First Line	:	1605 EDDINGTON RD
Second Line	:	UP
City	:	E CLEVELAND
State	:	OH
Zip	:	44118-5401
Country	:	US
Telephone Number	:	216-371-3962
Fax Number	:

Provider Business Practice Location Address
First Line	:	1605 EDDINGTON RD
Second Line	:	UP
City	:	EAST CLEVELAND
State	:	OH
Zip	:	44118-5401
Country	:	US
Telephone Number	:	216-371-3962
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/24/2008
Last Update Date	:	09/24/2008

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