1043794704 NPI number — MS. CHONG-AE DONAHUE MSN, APRN, NP-C

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043794704 NPI number — MS. CHONG-AE DONAHUE MSN, APRN, NP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DONAHUE
Provider First Name:
CHONG-AE
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSN, APRN, NP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DONAHUE
Provider Other First Name:
CHONG-AE
Provider Other Middle Name:
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1043794704
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/21/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
C/O ST MARY'S HEALTH SYSTEM - PROVIDER ENROLLMENT
Provider Second Line Business Mailing Address:
PO BOX 7291
Provider Business Mailing Address City Name:
LEWISTON
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04243-7291
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-777-8695
Provider Business Mailing Address Fax Number:
207-777-8800

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
460 AMHERST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NASHUA
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03063-1220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-883-7970
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/19/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  061386-23 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3114299 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".




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