Provider Demographics
NPI:1679718746
Name:EHRMAN, DONOVAN VIRGIL (FNP)
Entity type:Individual
Prefix:
First Name:DONOVAN
Middle Name:VIRGIL
Last Name:EHRMAN
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 16TH ST
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80631-5154
Mailing Address - Country:US
Mailing Address - Phone:970-350-6257
Mailing Address - Fax:970-350-6292
Practice Address - Street 1:1801 16TH ST
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-5154
Practice Address - Country:US
Practice Address - Phone:970-350-6257
Practice Address - Fax:970-350-6292
Is Sole Proprietor?:No
Enumeration Date:2008-12-03
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONP-5876363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO51827271Medicaid
COCOA102650Medicare PIN
COCO304294Medicare PIN