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NPI Code Detail

MEDICARE: DR. JESSICA LYNN DONNER MD

MEDICARE: DR. JESSICA LYNN DONNER MD
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
1207V00000XObstetrics & Gynecology Physician50130CO
2207V00000XObstetrics & Gynecology Physician9276SD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1215137179
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JESSICA LYNN DONNER MD
Provider Business Mailing Address
First Line : 353 FAIRMONT BLVD
Second Line : ATTEN CHRISTIE MSS
City : RAPID CITY
State : SD
Zip : 57701-7350
Country : US
Telephone Number : 303-690-2198
Fax Number : 303-369-1807
Provider Business Practice Location Address
First Line : 1445 NORTH AVE
Second Line :
City : SPEARFISH
State : SD
Zip : 57783-1552
Country : US
Telephone Number : 605-644-4170
Fax Number : 604-644-4198
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/19/2007
Last Update Date : 08/14/2014

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