Provider Demographics
NPI:1457313546
Name:DONAGHEY, ELIZABETH (NP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:DONAGHEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:829 MAIN ROAD
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:MA
Mailing Address - Zip Code:02790-4394
Mailing Address - Country:US
Mailing Address - Phone:508-636-5101
Mailing Address - Fax:508-636-3651
Practice Address - Street 1:829 MAIN ROAD
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:MA
Practice Address - Zip Code:02790-4394
Practice Address - Country:US
Practice Address - Phone:508-636-5101
Practice Address - Fax:508-636-3651
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RINPP25578363LA2200X
MA146212363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0354121Medicaid
RI23954OtherBCBS-RHODE ISLAND
MA500023784OtherRAILROAD MEDICARE
RIED45782Medicaid
MANP2793OtherBCBS-MA
MANP2793OtherBCBS-MA
MANP2793Medicare PIN