Provider Demographics
NPI:1942290697
Name:COLLIER, DONNA LEE (CRNA)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:LEE
Last Name:COLLIER
Suffix:
Gender:F
Credentials:CRNA
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 15645
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89114-5645
Mailing Address - Country:US
Mailing Address - Phone:702-240-8847
Mailing Address - Fax:
Practice Address - Street 1:2450 W CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-2179
Practice Address - Country:US
Practice Address - Phone:702-877-8660
Practice Address - Fax:702-258-1322
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN216887L367500000X
NVCRNA000319367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1942290697Medicaid
S70401Medicare UPIN
NV1942290697Medicaid