MEDICARE: KRISTINA ANN DONOVAN RN, FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	251391	MA
2	363LF0000X	Family Nurse Practitioner	RN251391	MA

General Provider Information

NPI Number	:	1083682397
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTINA ANN DONOVAN RN, FNP

Provider Business Mailing Address
First Line	:	8 FOSSDALE RD
Second Line	:
City	:	DORCHESTER CENTER
State	:	MA
Zip	:	02124-5016
Country	:	US
Telephone Number	:	617-282-3446
Fax Number	:

Provider Business Practice Location Address
First Line	:	7 ELM AVE
Second Line	:
City	:	QUINCY
State	:	MA
Zip	:	02170-2923
Country	:	US
Telephone Number	:	617-770-2211
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/11/2006
Last Update Date	:	03/28/2012

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