Provider Demographics
NPI:1669656187
Name:AGAVE, DONNA M (APRN)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:M
Last Name:AGAVE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:
Other - Last Name:ABARBANEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:67 SOUTH BEDFORD ST STE 400W
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:67 SOUTH BEDFORD ST STE 400W
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803
Practice Address - Country:US
Practice Address - Phone:781-773-8200
Practice Address - Fax:650-282-4462
Is Sole Proprietor?:No
Enumeration Date:2007-12-19
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA149537364SP0808X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA149537OtherLICENSE