MEDICARE: ALEXIS DONOVAN NP

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
1	363LW0102X	Women's Health Nurse Practitioner	421902	NY

General Provider Information

NPI Number	:	1922930791
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXIS DONOVAN NP

Provider Business Mailing Address
First Line	:	23 SAINT CHARLES PL
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11216-4108
Country	:	US
Telephone Number	:	718-344-7815
Fax Number	:

Provider Business Practice Location Address
First Line	:	23 SAINT CHARLES PL
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11216-4108
Country	:	US
Telephone Number	:	718-344-7815
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2026
Last Update Date	:	06/03/2026

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