Provider Demographics
NPI:1184999468
Name:DONOHUE-GONZALEZ, KRISTEN (NP)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:DONOHUE-GONZALEZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:DONOHUE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:1 BLACHLEY RD
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-0002
Mailing Address - Country:US
Mailing Address - Phone:203-276-2277
Mailing Address - Fax:203-276-2278
Practice Address - Street 1:1 BLACHLEY RD
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-0002
Practice Address - Country:US
Practice Address - Phone:203-276-2277
Practice Address - Fax:203-276-2278
Is Sole Proprietor?:No
Enumeration Date:2012-03-20
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6584363LF0000X
NY337174364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA60432Medicare UPIN