Provider Demographics
NPI:1720130933
Name:DONEGAN, MONICA F (PA)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:F
Last Name:DONEGAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1607 LINCOLN WAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2462
Mailing Address - Country:US
Mailing Address - Phone:208-667-5483
Mailing Address - Fax:208-667-7062
Practice Address - Street 1:1607 LINCOLN WAY
Practice Address - Street 2:SUITE 200
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814
Practice Address - Country:US
Practice Address - Phone:208-667-5483
Practice Address - Fax:208-667-7062
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDPA105207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID804051700Medicaid
IDPENDINGMedicare PIN
ID804051700Medicaid