Liezl Rasgo Didonato, CRNP

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

SP012329 Issued in PA

Practice address

111 S 11TH St
Suite 6270
Philadelphia, PA 19107-4824

Phone

(215) 955-4912

Fax

(215) 923-0835

NPI assigned

Mar 7, 2014

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1394150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1437523200000",
    "number": "1114343654",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 S 11TH ST",
            "address_2": "SUITE 6270",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191074824",
            "telephone_number": "215-955-8304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 S 11TH ST",
            "address_2": "SUITE 6270",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191074824",
            "telephone_number": "215-955-4912",
            "fax_number": "215-923-0835"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIDONATO",
        "first_name": "LIEZL",
        "middle_name": "RASGO",
        "name_prefix": "Mrs.",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-03-07",
        "last_updated": "2015-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "PA",
            "license": "SP012329",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102925771",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• John Wesley Diddle, MD
• Concetta Didomenico, PNP-BC
• Kristin Marie Didomenico, M.D.
• Laura Michele Didomenico, M.D.
• Angelarosa Didonato, CRNA
• Brendon L Didonna, PAC
• Lilliana Didovic, MA
• Jenny Diec, PHARM D.
• Robert J Diecidue, DMD, MD
• Matthew Diedrich, CRNA

• Adult Health Nurse Practitioner in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Adult Health Nurse Practitioner in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.