Healthcare Provider Details

I. General information

NPI: 1730498098
Provider Name (Legal Business Name): COLLEEN G DONNELLY CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2010
Last Update Date: 07/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 MERRIMACK ST
LAWRENCE MA
01843-1740
US

IV. Provider business mailing address

360 MERRIMACK ST
LAWRENCE MA
01843-1740
US

V. Phone/Fax

Practice location:
  • Phone: 978-557-8800
  • Fax: 978-557-8633
Mailing address:
  • Phone: 978-557-8800
  • Fax: 978-557-8633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2290297
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: