Healthcare Provider Details

I. General information

NPI: 1679267090
Provider Name (Legal Business Name): PATRICIA MARIE DONEGAN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2023
Last Update Date: 06/13/2023
Certification Date: 06/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 ANITA ST
PUEBLO CO
81001-2122
US

IV. Provider business mailing address

1958 RIPPLE RIDGE RD
COLORADO SPRINGS CO
80921-1913
US

V. Phone/Fax

Practice location:
  • Phone: 719-225-6510
  • Fax:
Mailing address:
  • Phone: 303-704-0912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0998752-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: