Provider Demographics
NPI:1053813956
Name:GOTZIAN, DONNA (RN)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:GOTZIAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18874 243RD AVE NW
Mailing Address - Street 2:
Mailing Address - City:BIG LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55309-8208
Mailing Address - Country:US
Mailing Address - Phone:763-263-6440
Mailing Address - Fax:763-263-6440
Practice Address - Street 1:18874 243RD AVE NW
Practice Address - Street 2:
Practice Address - City:BIG LAKE
Practice Address - State:MN
Practice Address - Zip Code:55309-8208
Practice Address - Country:US
Practice Address - Phone:763-263-6440
Practice Address - Fax:763-263-6440
Is Sole Proprietor?:No
Enumeration Date:2018-03-06
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1454202163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health