Healthcare Provider Details

I. General information

NPI: 1629314075
Provider Name (Legal Business Name): NICOLE M DONAGER CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE M TERWILLIGER CNM

II. Dates (important events)

Enumeration Date: 12/12/2012
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 COLCHESTER AVE
BURLINGTON VT
05401-1473
US

IV. Provider business mailing address

671 VANDALIA ST
SAINT PAUL MN
55114-1312
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-0000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number606
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number101.0139582
License Number StateVT
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11700
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: