Provider Demographics
NPI:1821177114
Name:MIGANOWICZ, DONNA KATHLEEN (APRN, BC, PC)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:KATHLEEN
Last Name:MIGANOWICZ
Suffix:
Gender:F
Credentials:APRN, BC, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 MILL ST
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:MA
Mailing Address - Zip Code:02478-1041
Mailing Address - Country:US
Mailing Address - Phone:800-230-8764
Mailing Address - Fax:
Practice Address - Street 1:216 LAKE RD
Practice Address - Street 2:MCLEAN CENTER AT NAUKEAG
Practice Address - City:ASHBURNHAM
Practice Address - State:MA
Practice Address - Zip Code:01430-1207
Practice Address - Country:US
Practice Address - Phone:800-230-8764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA115945364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPN0726OtherBCBS
MAN50073Medicare ID - Type Unspecified