Provider Demographics
NPI:1326268673
Name:DONOVAN, AMY LYNN (RN,CCM,QRP)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:LYNN
Last Name:DONOVAN
Suffix:
Gender:F
Credentials:RN,CCM,QRP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 WASHINGTON CIR
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:WV
Mailing Address - Zip Code:25526-9619
Mailing Address - Country:US
Mailing Address - Phone:304-757-2621
Mailing Address - Fax:
Practice Address - Street 1:144 WASHINGTON CIR
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526-9619
Practice Address - Country:US
Practice Address - Phone:304-757-2621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV52804171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV00000013Medicare UPIN