1780856013 NPI number — DR. KRISTINA JANSSEN DONOVAN D.O.

Table of content: DR. KRISTINA JANSSEN DONOVAN D.O. (NPI 1780856013)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780856013 NPI number — DR. KRISTINA JANSSEN DONOVAN D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DONOVAN
Provider First Name:
KRISTINA
Provider Middle Name:
JANSSEN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JANSSEN
Provider Other First Name:
KRISTINA
Provider Other Middle Name:
LOUISE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1780856013
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/21/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4715 WHITESBURG DR SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUNTSVILLE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35802-1632
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-881-5151
Provider Business Mailing Address Fax Number:
256-880-3939

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4715 WHITESBURG DRIVE
Provider Second Line Business Practice Location Address:
SPORTSMED ORTHOPAEDIC SURGERY AND SPINE CENTER
Provider Business Practice Location Address City Name:
HUNTSVILLE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-881-5151
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/26/2008

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: 2081P2900X , with the licence number:  DO.1109 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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