Basic Information
| Provider Information | |||||||||
| NPI: | 1669400123 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VONHAGEL | ||||||||
| FirstName: | DONNA | ||||||||
| MiddleName: | JEAN | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2151 OLD ROCKY RIDGE ROAD | ||||||||
| Address2: | SUITE 106 | ||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352167251 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059891091 | ||||||||
| FaxNumber: | 2059891087 | ||||||||
| Practice Location | |||||||||
| Address1: | 1201 11TH AVE S | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352053410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059307296 | ||||||||
| FaxNumber: | 2059307256 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2006 | ||||||||
| LastUpdateDate: | 09/29/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/29/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 1-048855 | AL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 1669400123 | 05 | AL | MEDICAID | 515-45848 | 01 | AL | BC BS OF AL | OTHER | 204346544 | 01 | AL | CHAMPUS | OTHER |