Provider Demographics
NPI:1306841481
Name:ROBINETT, DONNA JEAN (CRNA)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:JEAN
Last Name:ROBINETT
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:JEAN
Other - Last Name:BARNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:106 GETTYSBURG WAY
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-7787
Mailing Address - Country:US
Mailing Address - Phone:601-466-4286
Mailing Address - Fax:
Practice Address - Street 1:106 GETTYSBURG WAY
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-7787
Practice Address - Country:US
Practice Address - Phone:601-466-4286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR858794367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06184522Medicaid
MS06184522Medicaid
MS430001759Medicare ID - Type Unspecified
MS06184522Medicaid
MS512G700151OtherGROUP MEDICARE PTAN FOR SOUTHERN EYE SURGERY CENTER LLC
MSR16074Medicare UPIN