Provider Demographics
NPI:1518349505
Name:DONNER, KIRSTEN (PA-C)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:
Last Name:DONNER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KIRSTEN
Other - Middle Name:
Other - Last Name:GETTENDORF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3300 WESTHILL DR
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-4710
Mailing Address - Country:US
Mailing Address - Phone:715-847-2605
Mailing Address - Fax:
Practice Address - Street 1:3300 WESTHILL DR
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-4710
Practice Address - Country:US
Practice Address - Phone:715-847-2605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-25
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3588-23363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI3588-23OtherWI LICENSE