Provider Demographics
NPI:1558462036
Name:DONOVAN, LEAH TAYLOR (RN, APNP)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:TAYLOR
Last Name:DONOVAN
Suffix:
Gender:F
Credentials:RN, APNP
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Other - Last Name:
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Mailing Address - Street 1:4425 N PORT WASHINGTON RD
Mailing Address - Street 2:ATTN: CSMCP CLINIC CREDENTIALING
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-1082
Mailing Address - Country:US
Mailing Address - Phone:414-961-7250
Mailing Address - Fax:414-961-2795
Practice Address - Street 1:375 W RIVER WOODS PKWY
Practice Address - Street 2:SUITE 205
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53212-1080
Practice Address - Country:US
Practice Address - Phone:414-961-7250
Practice Address - Fax:414-961-2795
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2011-11-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI2570-033363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily