Provider Demographics
NPI:1932296332
Name:WITSBERGER, DONNA J (CRNA)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:J
Last Name:WITSBERGER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:CB 8054
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:800-862-9980
Mailing Address - Fax:314-362-1185
Practice Address - Street 1:14532 S OUTER 40 RD
Practice Address - Street 2:DEPT ANESTHESIOLOGY
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-5705
Practice Address - Country:US
Practice Address - Phone:800-862-9980
Practice Address - Fax:314-362-1185
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO089662367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO918438607Medicaid
MO918438607Medicaid
MO821690171Medicare PIN
000040056Medicare PIN
371414103OtherEIN
514184OtherHEALTHLINK
490005696OtherRAILROAD MEDICARE
P00443325OtherRAILROAD MEDICARE
000015519Medicare PIN
821695519Medicare PIN