Provider Demographics
NPI:1487692141
Name:LAMONT, DONNA (CRNA)
Entity type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:
Last Name:LAMONT
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 JERRY MURPHY RD
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81001-1046
Mailing Address - Country:US
Mailing Address - Phone:719-545-9715
Mailing Address - Fax:719-545-2054
Practice Address - Street 1:4100 JERRY MURPHY RD
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81001-1046
Practice Address - Country:US
Practice Address - Phone:719-545-9715
Practice Address - Fax:719-545-2054
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO64521367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
COLADL0527OtherBLUE CROSS BLUE SHIELD
CO01370485Medicaid
CO430053663OtherRR MEDICARE PROVIDER NUMB
CO01370485Medicaid
COLADL0527OtherBLUE CROSS BLUE SHIELD