Provider Demographics
NPI:1629314075
Name:DONAGER, NICOLE M (CNM)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:M
Last Name:DONAGER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:M
Other - Last Name:TERWILLIGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:1200 LAGOON AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-2077
Mailing Address - Country:US
Mailing Address - Phone:917-882-0934
Mailing Address - Fax:
Practice Address - Street 1:1200 LAGOON AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-2077
Practice Address - Country:US
Practice Address - Phone:917-882-0934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-12
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT176312176B00000X, 363LP2300X
MN11700363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No176B00000XOther Service ProvidersMidwife
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care