Provider Demographics
NPI:1619118403
Name:DONOGHUE, MICHELE MONDAY (FNP)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:MONDAY
Last Name:DONOGHUE
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 70
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:VA
Mailing Address - Zip Code:23974-0070
Mailing Address - Country:US
Mailing Address - Phone:434-696-2165
Mailing Address - Fax:434-696-1557
Practice Address - Street 1:8631 NAMOZINE ROAD
Practice Address - Street 2:
Practice Address - City:AMELIA
Practice Address - State:VA
Practice Address - Zip Code:23002
Practice Address - Country:US
Practice Address - Phone:804-561-4333
Practice Address - Fax:804-561-6263
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-09
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001131752363LF0000X
VA0024168232363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily