Provider Demographics
NPI:1073558011
Name:DONOVAN, MARGUERITA ROSE (CRNA)
Entity Type:Individual
Prefix:MS
First Name:MARGUERITA
Middle Name:ROSE
Last Name:DONOVAN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MS
Other - First Name:RITA
Other - Middle Name:R
Other - Last Name:DONOVAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:1901 RANDOLPH RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28207-1101
Mailing Address - Country:US
Mailing Address - Phone:704-316-1594
Mailing Address - Fax:704-316-9771
Practice Address - Street 1:1901 RANDOLPH RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1101
Practice Address - Country:US
Practice Address - Phone:704-316-1594
Practice Address - Fax:704-316-9771
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR40479367500000X
NC478367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM15434729Medicaid
NM202005158OtherPHP MOO SALUD
AZ069825Medicaid
NM202005158OtherPHP MOO SALUD