Healthcare Provider Details

I. General information

NPI: 1467670158
Provider Name (Legal Business Name): MARYELLEN DONNELLY MSN, ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 E MADISON ST
SEATTLE WA
98122-2959
US

IV. Provider business mailing address

2048 MINOR AVE E
SEATTLE WA
98102-7207
US

V. Phone/Fax

Practice location:
  • Phone: 206-328-7722
  • Fax:
Mailing address:
  • Phone: 206-322-7824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberAP30005671
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: