Healthcare Provider Details

I. General information

NPI: 1457288995
Provider Name (Legal Business Name): CAITLIN KERWIN DONOVAN
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12728 LEE RD
TRUCKEE CA
96161-5019
US

IV. Provider business mailing address

10956 DONNER PASS RD
TRUCKEE CA
96161-4861
US

V. Phone/Fax

Practice location:
  • Phone: 650-454-6939
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95238474
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: