Provider Demographics
NPI:1275510109
Name:DONOHOE, SOUMYA (MN, ARNP)
Entity Type:Individual
Prefix:
First Name:SOUMYA
Middle Name:
Last Name:DONOHOE
Suffix:
Gender:F
Credentials:MN, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 9TH AVE
Mailing Address - Street 2:MS:C2-HEM
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-2756
Mailing Address - Country:US
Mailing Address - Phone:206-223-6193
Mailing Address - Fax:206-341-0007
Practice Address - Street 1:1100 9TH AVE
Practice Address - Street 2:MS:C2-HEM
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-2756
Practice Address - Country:US
Practice Address - Phone:206-287-6226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60115313363L00000X
WAAP60116015363L00000X
IL209004792363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILQ09277Medicare UPIN
ILK04307Medicare ID - Type UnspecifiedMEDICARE #