Provider Demographics
NPI:1588667166
Name:DONNELL, DEANNA C (CNM)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:C
Last Name:DONNELL
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:DEANNA
Other - Middle Name:C
Other - Last Name:LAWLESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:2305 SOUTH 65 HIGHWAY
Mailing Address - Street 2:BUILDING A
Mailing Address - City:MARSHALL
Mailing Address - State:MO
Mailing Address - Zip Code:65340-3702
Mailing Address - Country:US
Mailing Address - Phone:660-886-7800
Mailing Address - Fax:660-831-3346
Practice Address - Street 1:2305 SOUTH 65 HIGHWAY
Practice Address - Street 2:BUILDING A
Practice Address - City:MARSHALL
Practice Address - State:MO
Practice Address - Zip Code:65340-3702
Practice Address - Country:US
Practice Address - Phone:660-886-7800
Practice Address - Fax:660-831-3346
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO150934367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1588667166Medicaid
MOH62C064Medicare PIN
MOP70750Medicare UPIN