Healthcare Provider Details

I. General information

NPI: 1689700676
Provider Name (Legal Business Name): DONALD W SHINSKIE CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 09/29/2020
Certification Date: 09/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3017 13TH ST
GULFPORT MS
39501-1833
US

IV. Provider business mailing address

435 THOMAS ST
BAY ST LOUIS MS
39520-2019
US

V. Phone/Fax

Practice location:
  • Phone: 228-831-0050
  • Fax:
Mailing address:
  • Phone: 910-389-1260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number170203
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2206
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0001160419
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPN0000011680
License Number StateTN
# 5
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN279123L
License Number StatePA
# 6
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number901620
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: