MEDICARE: DONNA WIRT DNP, FNP-BC, MSCP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	A179878	IA

General Provider Information

NPI Number	:	1093559981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONNA WIRT DNP, FNP-BC, MSCP

Provider Business Mailing Address
First Line	:	2900 DIVISION ST
Second Line	:
City	:	BURLINGTON
State	:	IA
Zip	:	52601-1616
Country	:	US
Telephone Number	:	319-601-5686
Fax Number	:	319-575-6054

Provider Business Practice Location Address
First Line	:	2900 DIVISION ST
Second Line	:
City	:	BURLINGTON
State	:	IA
Zip	:	52601-1616
Country	:	US
Telephone Number	:	319-601-5686
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2024
Last Update Date	:	05/11/2026

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