Healthcare Provider Details

I. General information

NPI: 1871636019
Provider Name (Legal Business Name): DONNA M GOVEN N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 09/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 WRIGHT ST
PALMER MA
01069-1138
US

IV. Provider business mailing address

302 JUNE ST
WORCESTER MA
01602-3258
US

V. Phone/Fax

Practice location:
  • Phone: 413-283-7651
  • Fax: 413-284-5117
Mailing address:
  • Phone: 508-756-2060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number164210
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: