Provider Demographics
NPI:1336490804
Name:DONAHUE, NICOLE M (CPNP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:M
Last Name:DONAHUE
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 SILVER ST
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-5813
Mailing Address - Country:US
Mailing Address - Phone:207-873-5437
Mailing Address - Fax:207-861-5448
Practice Address - Street 1:159 SILVER ST
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-5813
Practice Address - Country:US
Practice Address - Phone:207-873-5437
Practice Address - Fax:207-861-5448
Is Sole Proprietor?:No
Enumeration Date:2012-09-25
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP121090363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics