Provider Demographics
NPI:1740626803
Name:DONOHUE, DIANE MAURO (APRN)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:MAURO
Last Name:DONOHUE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 MILL HILL AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06610-2826
Mailing Address - Country:US
Mailing Address - Phone:203-481-2280
Mailing Address - Fax:
Practice Address - Street 1:420 E MAIN ST
Practice Address - Street 2:BLD. 2, STE. 3
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-2940
Practice Address - Country:US
Practice Address - Phone:203-481-2280
Practice Address - Fax:203-481-2275
Is Sole Proprietor?:No
Enumeration Date:2013-05-16
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP012887363LF0000X
OHCOA.17537-NP363LF0000X
CT006765363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily