Provider Demographics
NPI:1740583517
Name:HORMILLOSA, DONNA LYNN (RN)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:LYNN
Last Name:HORMILLOSA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:17230 NOOPIMING DR
Mailing Address - Street 2:
Mailing Address - City:ONAMIA
Mailing Address - State:MN
Mailing Address - Zip Code:56359-4522
Mailing Address - Country:US
Mailing Address - Phone:320-532-7776
Mailing Address - Fax:320-532-7524
Practice Address - Street 1:17230 NOOPIMING DR
Practice Address - Street 2:
Practice Address - City:ONAMIA
Practice Address - State:MN
Practice Address - Zip Code:56359-4522
Practice Address - Country:US
Practice Address - Phone:320-532-7776
Practice Address - Fax:320-532-7524
Is Sole Proprietor?:No
Enumeration Date:2010-12-16
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MNR 198947-6163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse