Healthcare Provider Details

I. General information

NPI: 1174431936
Provider Name (Legal Business Name): LAUREN DONOVAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20817 17TH AVE S
DES MOINES WA
98198-7665
US

IV. Provider business mailing address

9109 203RD AVE E
BONNEY LAKE WA
98391-6384
US

V. Phone/Fax

Practice location:
  • Phone: 206-257-6200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number61064982
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: