Provider Demographics
NPI:1790868370
Name:NURSS, DONNA M (APRN)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:M
Last Name:NURSS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:
Other - Last Name:HENDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:1300 E A ST STE 201
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-2252
Mailing Address - Country:US
Mailing Address - Phone:307-235-3333
Mailing Address - Fax:307-266-5155
Practice Address - Street 1:1300 EAST A STREET
Practice Address - Street 2:STE 201
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2252
Practice Address - Country:US
Practice Address - Phone:307-235-3333
Practice Address - Fax:307-266-5155
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY13302 248363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY311578OtherBLUE CROSS BLUE SHIELD
WY124143500Medicaid
WY124143500Medicaid