Provider Demographics
NPI:1467454413
Name:MATHIS, DONNA (FNP)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:MATHIS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 N HOSPITAL DR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:PRICE
Mailing Address - State:UT
Mailing Address - Zip Code:84501-4216
Mailing Address - Country:US
Mailing Address - Phone:435-637-6348
Mailing Address - Fax:435-637-6422
Practice Address - Street 1:280 N HOSPITAL DR
Practice Address - Street 2:STE 3
Practice Address - City:PRICE
Practice Address - State:UT
Practice Address - Zip Code:84501-4216
Practice Address - Country:US
Practice Address - Phone:435-637-6348
Practice Address - Fax:435-637-6422
Is Sole Proprietor?:No
Enumeration Date:2005-06-02
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT2094274405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTDD8580OtherPALMETTO GBA- RAILROAD MEDICARE
UT005712602Medicare PIN
UTP99642Medicare UPIN