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General NPI Number Information
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NPI Number | 1477723427
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Entity Type | Organization
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Legal Business Name | CLARICE ELLEN DONAHUE LLC
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Dates
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Enumeration Date | 03/06/2008
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Last Update Date | 03/06/2008
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Provider Practice Location Address
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Address Line | 695 HIGHWAY A1A
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City | VERO BEACH
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State | FL
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Zip | 32963-2510
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Country | US
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Telephone | 772-532-9124
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Fax |
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Provider Business Mailing Address
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Address Line | 695 HIGHWAY A1A
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City | VERO BEACH
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State | FL
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Zip | 32963-2510
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Country | US
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Telephone | 772-532-9124
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CLARICE ELLEN DONAHUE
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Credential | ARNP
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Telephone | 772-532-9124
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | ARNP3198122
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License Number State | FL
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