MEDICARE: PATRICIA DONAHUE PA

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	363A00000X	Physician Assistant	5601012390	MI

General Provider Information

NPI Number	:	1972841419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA DONAHUE PA

Provider Business Mailing Address
First Line	:	100 MICHIGAN ST NE # MC845
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49503-2560
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2776 S STATE RD
Second Line	:
City	:	IONIA
State	:	MI
Zip	:	48846-8472
Country	:	US
Telephone Number	:	616-775-7500
Fax Number	:

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

Provider Enumeration Date	:	01/17/2013
Last Update Date	:	08/06/2024

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Directions to “ PATRICIA DONAHUE PA” Practice Location

Language	Start Address	Practice Location

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