Provider Demographics
NPI:1407160435
Name:DONDERO, KATERINA ANGELICA (CNM, APRN)
Entity Type:Individual
Prefix:
First Name:KATERINA
Middle Name:ANGELICA
Last Name:DONDERO
Suffix:
Gender:F
Credentials:CNM, APRN
Other - Prefix:
Other - First Name:KATERINA
Other - Middle Name:ANGELICA
Other - Last Name:MOOERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM, APRN
Mailing Address - Street 1:PO BOX 412503
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-2503
Mailing Address - Country:US
Mailing Address - Phone:617-726-3884
Mailing Address - Fax:
Practice Address - Street 1:770 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-3437
Practice Address - Country:US
Practice Address - Phone:603-742-0101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-02
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH067371-23367A00000X
MARN2262238363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3143548Medicaid