Healthcare Provider Details

I. General information

NPI: 1922161801
Provider Name (Legal Business Name): MARINA DONAHUE N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARINA TUCKER

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 09/24/2020
Certification Date: 09/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 LONGWOOD AVE
BOSTON MA
02115-5804
US

IV. Provider business mailing address

221 LONGWOOD AVE
BOSTON MA
02115-5804
US

V. Phone/Fax

Practice location:
  • Phone: 617-732-5556
  • Fax: 617-525-0436
Mailing address:
  • Phone: 617-732-5556
  • Fax: 617-525-0436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN191587
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: