MEDICARE: ALLISON M DONOVAN

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	G175222	IA
2	363LF0000X	Family Nurse Practitioner	A157432	IA

General Provider Information

NPI Number	:	1306486030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLISON M DONOVAN

Provider Business Mailing Address
First Line	:	PO BOX 193
Second Line	:
City	:	NORTH LIBERTY
State	:	IA
Zip	:	52317-0193
Country	:	US
Telephone Number	:	319-499-5410
Fax Number	:

Provider Business Practice Location Address
First Line	:	565 CAMERON WAY STE 103
Second Line	:
City	:	NORTH LIBERTY
State	:	IA
Zip	:	52317-4868
Country	:	US
Telephone Number	:	319-499-5410
Fax Number	:	877-559-4490

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

Provider Enumeration Date	:	01/10/2020
Last Update Date	:	03/10/2025

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