Provider Demographics
NPI:1083755409
Name:JETT, DONNA VOGT (LPT)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:VOGT
Last Name:JETT
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 OAKBROOK DR
Mailing Address - Street 2:
Mailing Address - City:OWENSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65066-2745
Mailing Address - Country:US
Mailing Address - Phone:573-437-7186
Mailing Address - Fax:573-764-4219
Practice Address - Street 1:818 OAKBROOK DR
Practice Address - Street 2:
Practice Address - City:OWENSVILLE
Practice Address - State:MO
Practice Address - Zip Code:65066-2745
Practice Address - Country:US
Practice Address - Phone:573-437-7186
Practice Address - Fax:573-764-4219
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01303174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist