Provider Demographics
NPI:1356860886
Name:DONOVAN, TAYLOR (ARNP)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:DONOVAN
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8455 SE 69TH PL
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-5775
Mailing Address - Country:US
Mailing Address - Phone:206-455-5295
Mailing Address - Fax:
Practice Address - Street 1:509 OLIVE WAY STE 752
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-3171
Practice Address - Country:US
Practice Address - Phone:206-455-5295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-15
Last Update Date:2017-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60786235363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner