Provider Demographics
NPI:1235184342
Name:DONOHUE, PATRICK M (CRNA)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:M
Last Name:DONOHUE
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:528 WASHINGTON HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05661-8973
Mailing Address - Country:US
Mailing Address - Phone:802-888-4231
Mailing Address - Fax:802-888-8203
Practice Address - Street 1:528 WASHINGTON HIGHWAY
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:VT
Practice Address - Zip Code:05661-8973
Practice Address - Country:US
Practice Address - Phone:802-888-4231
Practice Address - Fax:802-888-8203
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRNA36580367500000X
MARN223523207L00000X, 367500000X
VT101-0034868367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1013371Medicaid
VTVN4147Medicare PIN