Provider Demographics
NPI:1083033625
Name:DE VILLIER, DONNA H
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:H
Last Name:DE VILLIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24600 MILLSTREAM DR
Mailing Address - Street 2:SUITE 340
Mailing Address - City:STONE RIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:20105-5685
Mailing Address - Country:US
Mailing Address - Phone:248-730-0985
Mailing Address - Fax:
Practice Address - Street 1:24600 MILLSTREAM DR
Practice Address - Street 2:SUITE 340
Practice Address - City:STONE RIDGE
Practice Address - State:VA
Practice Address - Zip Code:20105-5685
Practice Address - Country:US
Practice Address - Phone:248-730-0985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-10
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001236598363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health