Provider Demographics
NPI:1023228897
Name:MUHLENBECK, DONNA (CNM)
Entity type:Individual
Prefix:MS
First Name:DONNA
Middle Name:
Last Name:MUHLENBECK
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2790 GODWIN BLVD STE 360
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-8153
Mailing Address - Country:US
Mailing Address - Phone:757-539-3911
Mailing Address - Fax:757-925-0615
Practice Address - Street 1:2790 GODWIN BLVD STE 360
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-8153
Practice Address - Country:US
Practice Address - Phone:757-539-3911
Practice Address - Fax:757-925-0615
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024166133367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC790259HMedicaid
VA0024166133OtherLICENSE
VA1821133174Medicaid
NC790259HMedicaid
VAC05064Medicare PIN