Provider Demographics
NPI:1134734361
Name:VANGRIMBERGEN, DONNA
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:VANGRIMBERGEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5168 STATE ROUTE 9
Mailing Address - Street 2:
Mailing Address - City:SEDRO WOOLLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98284-8267
Mailing Address - Country:US
Mailing Address - Phone:360-320-7498
Mailing Address - Fax:
Practice Address - Street 1:13820 19TH AVE NE
Practice Address - Street 2:
Practice Address - City:TULALIP
Practice Address - State:WA
Practice Address - Zip Code:98271-6706
Practice Address - Country:US
Practice Address - Phone:425-238-3643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60274888163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse