Provider Demographics
NPI:1457448839
Name:DONOVAN, MARGERY ELLEN (APRN)
Entity Type:Individual
Prefix:
First Name:MARGERY
Middle Name:ELLEN
Last Name:DONOVAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MEDICAL CENTER DR
Mailing Address - Street 2:DHMC, DEPT OF ID
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03756-1000
Mailing Address - Country:US
Mailing Address - Phone:603-650-6060
Mailing Address - Fax:603-650-6110
Practice Address - Street 1:1 MEDICAL CENTER DR
Practice Address - Street 2:DHMC, DEPT OF ID
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03756-1000
Practice Address - Country:US
Practice Address - Phone:603-650-6060
Practice Address - Fax:603-650-6110
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH04610823363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3077111Medicaid
VT0NP3239Medicaid
NH3077111Medicaid
NHT400342568Medicare PIN