Healthcare Provider Details

I. General information

NPI: 1861321473
Provider Name (Legal Business Name): MS. AUBREY NICOLE DONAGHY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5750 FALLS DR
FORT WAYNE IN
46804-7147
US

IV. Provider business mailing address

14216 FLINT CT
LEO IN
46765-9691
US

V. Phone/Fax

Practice location:
  • Phone: 260-702-9898
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number9371-22-7668
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: