Healthcare Provider Details

I. General information

NPI: 1538149786
Provider Name (Legal Business Name): ANDREA BRUNHART DONALTY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3475 N SARATOGA ST NAVAL HOSPITAL OAK HARBOR
OAK HARBOR WA
98278-4927
US

IV. Provider business mailing address

420 LITTLE ACRES DR
OAK HARBOR WA
98277-9640
US

V. Phone/Fax

Practice location:
  • Phone: 360-257-9605
  • Fax: 360-257-9662
Mailing address:
  • Phone: 360-240-1188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101057907
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: