Provider Demographics
NPI:1285110106
Name:DONNELLY, ANJELICA (OD)
Entity type:Individual
Prefix:DR
First Name:ANJELICA
Middle Name:
Last Name:DONNELLY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MS
Other - First Name:ANJELICA
Other - Middle Name:
Other - Last Name:BOEMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:505 W HOLLIS ST STE 109
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03062-1386
Mailing Address - Country:US
Mailing Address - Phone:603-882-0311
Mailing Address - Fax:
Practice Address - Street 1:505 W HOLLIS ST STE 109
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03062-1386
Practice Address - Country:US
Practice Address - Phone:603-882-0311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-13
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0976152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist