Provider Demographics
NPI:1598186371
Name:DONOVAN, COLLEEN JEHNING (NP)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:JEHNING
Last Name:DONOVAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:THERESA
Other - Last Name:JEHNING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1200 N. STATE STREET
Mailing Address - Street 2:CLINIC TOWER RM. 2B300
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033
Mailing Address - Country:US
Mailing Address - Phone:323-409-6240
Mailing Address - Fax:323-441-8123
Practice Address - Street 1:2051 MARENGO ST.
Practice Address - Street 2:NICU
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033
Practice Address - Country:US
Practice Address - Phone:323-409-6240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-23
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA349815363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care