Provider Demographics
NPI:1043444300
Name:DONOHUE, SEAN (PA-C)
Entity type:Individual
Prefix:MR
First Name:SEAN
Middle Name:
Last Name:DONOHUE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:USA MEDDAC BAVARIA ATTN: CREDENTIALS OFFICE
Mailing Address - Street 2:CMR 411, BUILDING 700
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09112
Mailing Address - Country:US
Mailing Address - Phone:01149966-283-4720
Mailing Address - Fax:
Practice Address - Street 1:1801 31ST AVE SE
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98374-6320
Practice Address - Country:US
Practice Address - Phone:719-321-7973
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-14
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000OtherVAD000