Healthcare Provider Details

I. General information

NPI: 1427400043
Provider Name (Legal Business Name): KIERAN DONAGHEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2016
Last Update Date: 07/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 ENTERPRISE DR
AUGUSTA ME
04330-7997
US

IV. Provider business mailing address

15 ENTERPRISE DR
AUGUSTA ME
04330-7997
US

V. Phone/Fax

Practice location:
  • Phone: 207-621-8800
  • Fax: 207-621-8801
Mailing address:
  • Phone: 207-621-8800
  • Fax: 207-621-8801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN64256
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: