Provider Demographics
NPI:1770832800
Name:DONOVAN, JOANNE
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:
Last Name:DONOVAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2485 HOSPITAL DR STE 221
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-4103
Mailing Address - Country:US
Mailing Address - Phone:650-988-0235
Mailing Address - Fax:
Practice Address - Street 1:2485 HOSPITAL DR STE 221
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-4103
Practice Address - Country:US
Practice Address - Phone:650-988-0235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered