Provider Demographics
NPI:1447024906
Name:DONOVAN, ANDREA CHRISTINE (RN)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:CHRISTINE
Last Name:DONOVAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:WALPOLE
Mailing Address - State:MA
Mailing Address - Zip Code:02081-3531
Mailing Address - Country:US
Mailing Address - Phone:617-817-9959
Mailing Address - Fax:
Practice Address - Street 1:63 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:WALPOLE
Practice Address - State:MA
Practice Address - Zip Code:02081-3531
Practice Address - Country:US
Practice Address - Phone:617-817-9959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-14
Last Update Date:2023-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2284307163WG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0100XNursing Service ProvidersRegistered NurseGastroenterology