1598787483 NPI number — MS. JOAN M DONOVAN LMT

Table of content: MS. JOAN M DONOVAN LMT (NPI 1598787483)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598787483 NPI number — MS. JOAN M DONOVAN LMT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DONOVAN
Provider First Name:
JOAN
Provider Middle Name:
M
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LMT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ALGIERE
Provider Other First Name:
JOAN
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMT, MMT, NKT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1598787483
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/20/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4001 W CENTRAL AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TOLEDO
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43606-2204
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-367-1417
Provider Business Mailing Address Fax Number:
419-491-1122

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4001 W CENTRAL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TOLEDO
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43606-2204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-367-1417
Provider Business Practice Location Address Fax Number:
419-491-1122
Provider Enumeration Date:
07/23/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225700000X , with the licence number:  33.012746 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)