Provider Demographics
NPI:1326839515
Name:DONOVAN, JESSICA MARIE (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIE
Last Name:DONOVAN
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 COMMERCIAL AVE # 238
Mailing Address - Street 2:
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221-2232
Mailing Address - Country:US
Mailing Address - Phone:360-230-8350
Mailing Address - Fax:
Practice Address - Street 1:11080 HAPPY VALLEY RD
Practice Address - Street 2:
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221-4356
Practice Address - Country:US
Practice Address - Phone:360-230-8350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-15
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN61269518163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant