Provider Demographics
NPI:1487645297
Name:DONOHUE, SUSAN L (FNP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:L
Last Name:DONOHUE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 521404
Mailing Address - Street 2:3070 SOUTH HORSESHOE LAKE ROAD
Mailing Address - City:BIG LAKE
Mailing Address - State:AK
Mailing Address - Zip Code:99652-1404
Mailing Address - Country:US
Mailing Address - Phone:907-892-6602
Mailing Address - Fax:
Practice Address - Street 1:4200 LAKE OTIS PKWY
Practice Address - Street 2:SUITE 202
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5215
Practice Address - Country:US
Practice Address - Phone:907-338-2273
Practice Address - Fax:907-338-2284
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AK2707-0035363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily