Provider Demographics
NPI:1629313218
Name:KIEHNE, DONNA JEAN (ACNP-BC)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:JEAN
Last Name:KIEHNE
Suffix:
Gender:F
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1302 E 32ND ST
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88061-7215
Mailing Address - Country:US
Mailing Address - Phone:575-538-4112
Mailing Address - Fax:575-388-1791
Practice Address - Street 1:1302 E 32ND ST
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061
Practice Address - Country:US
Practice Address - Phone:575-538-4112
Practice Address - Fax:575-388-1791
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-07
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCMP02101363LA2100X
NMCNP-02101363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty