Provider Demographics
NPI:1093559981
Name:WIRT, DONNA (DNP, FNP-BC)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:WIRT
Suffix:
Gender:F
Credentials:DNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23591 90TH AVE
Mailing Address - Street 2:
Mailing Address - City:MEDIAPOLIS
Mailing Address - State:IA
Mailing Address - Zip Code:52637-9179
Mailing Address - Country:US
Mailing Address - Phone:319-759-1468
Mailing Address - Fax:
Practice Address - Street 1:220 MULBERRY ST STE A
Practice Address - Street 2:
Practice Address - City:WAPELLO
Practice Address - State:IA
Practice Address - Zip Code:52653-1576
Practice Address - Country:US
Practice Address - Phone:888-377-7791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA179878363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily