Individual
KATHLEEN DONOVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2 BROADWAY AVE, GORHAM, NH 03581-1502
(603) 752-2040
(603) 752-7797
Mailing address
133 PLEASANT ST, BERLIN, NH 03570-2006
(603) 752-2040
(603) 752-7797
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
0210072303
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020350051
FEDERAL TAX ID
—
01
—
0210072303
STATE LICENSE #
NH
01
—
23YP02556NH02
ANTHEM BC/BS
NH
05
—
30342708
—
NH
05
—
3072649
—
NH
01
—
5830418
AETNA GROUP
—
01
—
9680107001
CIGNA HEALTHCARE
NH
Enumeration date
08/10/2005
Last updated
03/07/2023
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