MEDICARE: MR. CHARLES M DONIGIAN JR. RN

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	163WC0200X	Critical Care Medicine Registered Nurse	143667	MO

General Provider Information

NPI Number	:	1114111523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHARLES M DONIGIAN JR. RN

Provider Business Mailing Address
First Line	:	1961 WEST WAY
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65203
Country	:	US
Telephone Number	:	573-256-7659
Fax Number	:

Provider Business Practice Location Address
First Line	:	1961 WEST WAY
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65203-8648
Country	:	US
Telephone Number	:	573-256-7659
Fax Number	:

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

Provider Enumeration Date	:	08/29/2007
Last Update Date	:	08/29/2007

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