Healthcare Provider Details

I. General information

NPI: 1780464057
Provider Name (Legal Business Name): NICHOLAS DONAT RN, PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2023
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 W BIG BEAVER RD STE 300
TROY MI
48084-3514
US

IV. Provider business mailing address

1700 W BIG BEAVER RD STE 300
TROY MI
48084-3514
US

V. Phone/Fax

Practice location:
  • Phone: 248-885-8887
  • Fax:
Mailing address:
  • Phone: 248-885-8887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4704447301
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: