Provider Demographics
NPI:1932642584
Name:VERMILLION, DONNA A (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:A
Last Name:VERMILLION
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 218
Mailing Address - Street 2:5641 E GREENLEAF LN
Mailing Address - City:STRAFFORD
Mailing Address - State:MO
Mailing Address - Zip Code:65757-0218
Mailing Address - Country:US
Mailing Address - Phone:561-213-7101
Mailing Address - Fax:
Practice Address - Street 1:5641 E GREENLEAF LN
Practice Address - Street 2:
Practice Address - City:STRAFFORD
Practice Address - State:MO
Practice Address - Zip Code:65757-8870
Practice Address - Country:US
Practice Address - Phone:561-213-7101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-30
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016036919363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily