Provider Demographics
NPI:1578763645
Name:FARMER, DONNA L (FNP)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:L
Last Name:FARMER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4951 BODHI WAY
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-6050
Mailing Address - Country:US
Mailing Address - Phone:707-754-0092
Mailing Address - Fax:707-754-0092
Practice Address - Street 1:4951 BODHI WAY
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-6050
Practice Address - Country:US
Practice Address - Phone:707-754-0092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-18
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA394674163WG0000X
CANP7477363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ17509ZMedicare PIN