Healthcare Provider Details

I. General information

NPI: 1114111523
Provider Name (Legal Business Name): CHARLES M DONIGIAN JR. RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2007
Last Update Date: 08/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1961 WEST WAY
COLUMBIA MO
65203-8648
US

IV. Provider business mailing address

1961 WEST WAY
COLUMBIA MO
65203
US

V. Phone/Fax

Practice location:
  • Phone: 573-256-7659
  • Fax:
Mailing address:
  • Phone: 573-256-7659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number143667
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: