Provider Demographics
NPI:1093394017
Name:DONAHUE, KATIE ANN (RN, IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:ANN
Last Name:DONAHUE
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:MISS
Other - First Name:KATIE
Other - Middle Name:ANN
Other - Last Name:POGUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7445 KELLY DR
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:MO
Mailing Address - Zip Code:63050-1215
Mailing Address - Country:US
Mailing Address - Phone:314-229-1283
Mailing Address - Fax:
Practice Address - Street 1:7445 KELLY DR
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:MO
Practice Address - Zip Code:63050-1215
Practice Address - Country:US
Practice Address - Phone:314-229-1283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-06
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007027783163W00000X
MOL-302749163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOL-302749OtherIBCLC CREDENTIAL NUMBER
MO2007027783OtherMO RN STATE LICENSE