Provider Demographics
NPI:1447494141
Name:ANTTILA, DONNA LYNN (RN, MCC)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:LYNN
Last Name:ANTTILA
Suffix:
Gender:F
Credentials:RN, MCC
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:LYNN
Other - Last Name:VAIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4141 E DICKENSON PL
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-6012
Mailing Address - Country:US
Mailing Address - Phone:303-504-6509
Mailing Address - Fax:303-782-0916
Practice Address - Street 1:1733 VINE ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-1119
Practice Address - Country:US
Practice Address - Phone:303-504-1032
Practice Address - Fax:303-782-0916
Is Sole Proprietor?:No
Enumeration Date:2009-04-24
Last Update Date:2009-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN-96896163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse