Provider Demographics
NPI:1083682397
Name:DONOVAN, KRISTINA ANN (RN, FNP)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:ANN
Last Name:DONOVAN
Suffix:
Gender:F
Credentials:RN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 FOSSDALE RD
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER CENTER
Mailing Address - State:MA
Mailing Address - Zip Code:02124-5016
Mailing Address - Country:US
Mailing Address - Phone:617-282-3446
Mailing Address - Fax:
Practice Address - Street 1:7 ELM AVE
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02170-2923
Practice Address - Country:US
Practice Address - Phone:617-770-2211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-11
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA251391163W00000X
MARN251391363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily