Healthcare Provider Details

I. General information

NPI: 1386637577
Provider Name (Legal Business Name): RHONDA C DONOVAN ANPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 01/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 S WOODS MILL RD STE 330
CHESTERFIELD MO
63017-3451
US

IV. Provider business mailing address

224 S WOODS MILL RD STE 330
CHESTERFIELD MO
63017-3451
US

V. Phone/Fax

Practice location:
  • Phone: 314-576-7013
  • Fax: 314-576-4047
Mailing address:
  • Phone: 314-576-7013
  • Fax: 314-576-4047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number105507
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0327586
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: