Provider Demographics
NPI:1154809515
Name:WIRTHLIN, DONNA M (MED, BSN, RN)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:M
Last Name:WIRTHLIN
Suffix:
Gender:F
Credentials:MED, BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 PARKVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:WINNEMUCCA
Mailing Address - State:NV
Mailing Address - Zip Code:89445-3231
Mailing Address - Country:US
Mailing Address - Phone:775-304-7301
Mailing Address - Fax:
Practice Address - Street 1:135 W 2ND ST
Practice Address - Street 2:
Practice Address - City:WINNEMUCCA
Practice Address - State:NV
Practice Address - Zip Code:89445-3406
Practice Address - Country:US
Practice Address - Phone:775-625-1718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-29
Last Update Date:2018-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRN56350163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse