Healthcare Provider Details

I. General information

NPI: 1154378180
Provider Name (Legal Business Name): MICHELE ANDREA DONEHOWER C.R.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10755 FALLS RD
LUTHERVILLE MD
21093-4515
US

IV. Provider business mailing address

PO BOX 64474
BALTIMORE MD
21264-4474
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-8964
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR068902
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: