Provider Demographics
NPI:1598749392
Name:DONOVAN, SHERRY (CRNA)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:
Last Name:DONOVAN
Suffix:
Gender:F
Credentials:CRNA
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 779
Mailing Address - Street 2:
Mailing Address - City:TAWAS CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48764-0779
Mailing Address - Country:US
Mailing Address - Phone:989-362-0153
Mailing Address - Fax:989-362-4683
Practice Address - Street 1:200 HEMLOCK ST
Practice Address - Street 2:
Practice Address - City:TAWAS CITY
Practice Address - State:MI
Practice Address - Zip Code:48763-9237
Practice Address - Country:US
Practice Address - Phone:989-362-0153
Practice Address - Fax:989-362-4683
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704153171367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1675653Medicaid
MI1675653Medicaid