Provider Demographics
NPI:1144215393
Name:HOLT - COSTAIN, DONNA CAROL (APRN,BC)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:CAROL
Last Name:HOLT - COSTAIN
Suffix:
Gender:F
Credentials:APRN,BC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:70 JUNGERMANN CIR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ST PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-1622
Mailing Address - Country:US
Mailing Address - Phone:636-926-0404
Mailing Address - Fax:636-939-3218
Practice Address - Street 1:70 JUNGERMANN CIR
Practice Address - Street 2:SUITE 101
Practice Address - City:ST PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-1622
Practice Address - Country:US
Practice Address - Phone:636-926-0404
Practice Address - Fax:636-939-3218
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-14
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2000168672363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily