Provider Demographics
NPI:1952325458
Name:MESSERSMITH, DONNA (APRNBC, CWCN)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:MESSERSMITH
Suffix:
Gender:F
Credentials:APRNBC, CWCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3340 E GOLDSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642
Mailing Address - Country:US
Mailing Address - Phone:541-881-2360
Mailing Address - Fax:541-881-2365
Practice Address - Street 1:1050 SW 3RD AVE
Practice Address - Street 2:STE 1600
Practice Address - City:ONTARIO
Practice Address - State:OR
Practice Address - Zip Code:97914
Practice Address - Country:US
Practice Address - Phone:541-881-2360
Practice Address - Fax:541-881-2365
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201250200NP-PP363LA2200X
IDNP898-A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health