Provider Demographics
NPI:1538539390
Name:VANTASSEL, DONNA M (RN, NP-C)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:M
Last Name:VANTASSEL
Suffix:
Gender:F
Credentials:RN, NP-C
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:M
Other - Last Name:BRUTSMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:408 WENDELL AVE
Mailing Address - Street 2:
Mailing Address - City:LEWISTOWN
Mailing Address - State:MT
Mailing Address - Zip Code:59457-2261
Mailing Address - Country:US
Mailing Address - Phone:406-535-1502
Mailing Address - Fax:
Practice Address - Street 1:408 WENDELL AVE
Practice Address - Street 2:
Practice Address - City:LEWISTOWN
Practice Address - State:MT
Practice Address - Zip Code:59457-2261
Practice Address - Country:US
Practice Address - Phone:406-535-1502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-05
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT99107363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology