Healthcare Provider Details

I. General information

NPI: 1528099165
Provider Name (Legal Business Name): KATHLEEN DONAGHEY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 11/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 WARREN AVE SUITE 302
EAST PROVIDENCE RI
02914-1430
US

IV. Provider business mailing address

900 WARREN AVE SUITE 302
EAST PROVIDENCE RI
02914-1430
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-8344
  • Fax: 401-444-4921
Mailing address:
  • Phone: 401-444-8344
  • Fax: 401-444-4921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number213617
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNPP37420
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: