Individual
DONNA MARIE IRISH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN-BC, GNP
Contact information
Practice address
1965 S FREMONT AVE, SUITE 300, SPRINGFIELD, MO 65804-2201
(417) 820-2936
(417) 820-7796
Mailing address
5087 S CLAY AVE, SPRINGFIELD, MO 65810-2855
(417) 885-0015
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
RN 152510
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
431560263149
TRICARE PROVIDER NUMBER
MO
01
—
RN152510
RN LICENSE
MO
Enumeration date
12/18/2006
Last updated
07/10/2007
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