Healthcare Provider Details

I. General information

NPI: 1760502603
Provider Name (Legal Business Name): KATE L DONNELLY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATE IRVINE

II. Dates (important events)

Enumeration Date: 03/31/2007
Last Update Date: 09/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1141 PEAR TREE LN
NAPA CA
94558
US

IV. Provider business mailing address

1100 TRANCAS ST 300
NAPA CA
94558-2921
US

V. Phone/Fax

Practice location:
  • Phone: 707-492-9236
  • Fax: 707-251-2993
Mailing address:
  • Phone: 707-492-9236
  • Fax: 425-949-5377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA19401
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: