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NPI Code Detail

MEDICARE: MARISSA PAIGE DONOVAN

MEDICARE: MARISSA PAIGE DONOVAN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1175T00000XPeer SpecialistTHW3827OR

General Provider Information

NPI Number : 1861041709
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARISSA PAIGE DONOVAN
Provider Business Mailing Address
First Line : 232 NW 6TH AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97209-3609
Country : US
Telephone Number : 503-294-1681
Fax Number :
Provider Business Practice Location Address
First Line : 726 W BURNSIDE ST
Second Line :
City : PORTLAND
State : OR
Zip : 97209-3515
Country : US
Telephone Number : 503-294-1681
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/04/2019
Last Update Date : 09/04/2019

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Directions to “ MARISSA PAIGE DONOVAN ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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