Provider Demographics
NPI:1558630533
Name:DONOVAN, MARY ELIZABETH (ACNP)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ELIZABETH
Last Name:DONOVAN
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:974 RIBAUT RD
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902-5486
Mailing Address - Country:US
Mailing Address - Phone:843-524-3344
Mailing Address - Fax:843-524-5574
Practice Address - Street 1:974 RIBAUT RD
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902-5486
Practice Address - Country:US
Practice Address - Phone:843-524-3344
Practice Address - Fax:843-524-5574
Is Sole Proprietor?:No
Enumeration Date:2011-12-21
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17510363LA2100X
GARN175949363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care