Healthcare Provider Details

I. General information

NPI: 1699689158
Provider Name (Legal Business Name): KRISTI DONOVAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1148 LONDON DERRY DR
SALINE MI
48176-9407
US

IV. Provider business mailing address

1148 LONDON DERRY DR
SALINE MI
48176-9407
US

V. Phone/Fax

Practice location:
  • Phone: 517-285-9956
  • Fax:
Mailing address:
  • Phone: 415-221-4810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number470252064
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: