Healthcare Provider Details

I. General information

NPI: 1720099534
Provider Name (Legal Business Name): DONNA J MUMERT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 CENTRACARE CIRCLE #1450, CENTRACARE CLINIC - PLAZA - FAMILY MEDICINE
ST CLOUD MN
56303-5000
US

IV. Provider business mailing address

1900 CENTRACARE CIRCLE #1450, CENTRACARE CLINIC - PLAZA - FAMILY MEDICINE
ST CLOUD MN
56303-5000
US

V. Phone/Fax

Practice location:
  • Phone: 320-229-4917
  • Fax:
Mailing address:
  • Phone: 320-229-4917
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number7421
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number37828
License Number StateIA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number49196
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: