Healthcare Provider Details

I. General information

NPI: 1043444300
Provider Name (Legal Business Name): SEAN DONOHUE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2009
Last Update Date: 05/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 31ST AVE SE
PUYALLUP WA
98374-6320
US

IV. Provider business mailing address

USA MEDDAC BAVARIA ATTN: CREDENTIALS OFFICE CMR 411, BUILDING 700
APO AE
09112
US

V. Phone/Fax

Practice location:
  • Phone: 719-321-7973
  • Fax:
Mailing address:
  • Phone: 011499662834720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: