Healthcare Provider Details

I. General information

NPI: 1144571746
Provider Name (Legal Business Name): ROSEELLEN M. DONOVAN R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2012
Last Update Date: 09/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

953 AUBURN ST
HANNIBAL NY
13074-2180
US

IV. Provider business mailing address

953 AUBURN ST
HANNIBAL NY
13074-2180
US

V. Phone/Fax

Practice location:
  • Phone: 315-564-7945
  • Fax: 315-564-7982
Mailing address:
  • Phone: 315-564-7945
  • Fax: 315-564-7982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number345571-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: