Provider Demographics
NPI:1396004875
Name:DONAR, AMANDA ROSE (RN)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:ROSE
Last Name:DONAR
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 1:156 E CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:SHULLSBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53586-9523
Mailing Address - Country:US
Mailing Address - Phone:608-732-8411
Mailing Address - Fax:
Practice Address - Street 1:156 E CHURCH ST
Practice Address - Street 2:
Practice Address - City:SHULLSBURG
Practice Address - State:WI
Practice Address - Zip Code:53586-9523
Practice Address - Country:US
Practice Address - Phone:608-732-8411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-03
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI177909-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse