1184907800 NPI number — MS. CARA-JEAN DONAGHEY ANP

Table of content: MS. CARA-JEAN DONAGHEY ANP (NPI 1184907800)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184907800 NPI number — MS. CARA-JEAN DONAGHEY ANP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DONAGHEY
Provider First Name:
CARA-JEAN
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
ANP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184907800
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/11/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
65 TENNEY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PELHAM
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03076-3145
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-771-3833
Provider Business Mailing Address Fax Number:
867-292-6142

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
155 MAIN DUNSTABLE RD STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NASHUA
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03060-3640
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-821-0056
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/20/2011

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: 363LA2200X , with the licence number:  RN184442 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: 060546-23 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2200X , with the licence number: 060546-23 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3087979 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".