Healthcare Provider Details

I. General information

NPI: 1447796966
Provider Name (Legal Business Name): EVELYN A DONAHUE CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2017
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 KERNAN DR
BALTIMORE MD
21207-6697
US

IV. Provider business mailing address

18823 NEW HAMPSHIRE AVE
ASHTON MD
20861-9791
US

V. Phone/Fax

Practice location:
  • Phone: 410-448-2500
  • Fax:
Mailing address:
  • Phone: 703-819-6611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAC009317
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: