Healthcare Provider Details

I. General information

NPI: 1427047174
Provider Name (Legal Business Name): DONNA HEITER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 07/13/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 BODIN CIR 60 MDG/SGCSA
TRAVIS AFB CA
94535-1809
US

IV. Provider business mailing address

PO BOX 5338
VACAVILLE CA
95696-5338
US

V. Phone/Fax

Practice location:
  • Phone: 707-423-3590
  • Fax:
Mailing address:
  • Phone: 707-423-3590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN269438L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: