Provider Demographics
NPI:1144571746
Name:DONOVAN, ROSEELLEN M (RN)
Entity Type:Individual
Prefix:MRS
First Name:ROSEELLEN
Middle Name:M
Last Name:DONOVAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:953 AUBURN ST
Mailing Address - Street 2:
Mailing Address - City:HANNIBAL
Mailing Address - State:NY
Mailing Address - Zip Code:13074-2180
Mailing Address - Country:US
Mailing Address - Phone:315-564-7945
Mailing Address - Fax:315-564-7982
Practice Address - Street 1:953 AUBURN ST
Practice Address - Street 2:
Practice Address - City:HANNIBAL
Practice Address - State:NY
Practice Address - Zip Code:13074-2180
Practice Address - Country:US
Practice Address - Phone:315-564-7945
Practice Address - Fax:315-564-7982
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-24
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY345571-1163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool