Healthcare Provider Details

I. General information

NPI: 1588604490
Provider Name (Legal Business Name): CHERYL M DONOVAN CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 CLINTON STREET THUNDERMIST HEALTH CENTER
WOONSOCKET RI
02895
US

IV. Provider business mailing address

191 SOCIAL STREET THUNDERMIST HEALTH CENTER
WOONSOCKET RI
02895
US

V. Phone/Fax

Practice location:
  • Phone: 401-767-4100
  • Fax: 401-235-6895
Mailing address:
  • Phone: 401-767-4163
  • Fax: 401-767-4165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMW00069
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: