=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215137179
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JESSICA LYNN DONNER MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/19/2007
-----------------------------------------------------
Last Update Date | 08/14/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1445 NORTH AVE
-----------------------------------------------------
City | SPEARFISH
-----------------------------------------------------
State | SD
-----------------------------------------------------
Zip | 57783-1552
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 605-644-4170
-----------------------------------------------------
Fax | 604-644-4198
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 353 FAIRMONT BLVD ATTEN CHRISTIE MSS
-----------------------------------------------------
City | RAPID CITY
-----------------------------------------------------
State | SD
-----------------------------------------------------
Zip | 57701-7350
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-690-2198
-----------------------------------------------------
Fax | 303-369-1807
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | 50130
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | 9276
-----------------------------------------------------
License Number State | SD
-----------------------------------------------------