Basic Information
| Provider Information | |||||||||
| NPI: | 1760502603 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DONNELLY | ||||||||
| FirstName: | KATE | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | PA-C | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | IRVINE | ||||||||
| OtherFirstName: | KATE | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1100 TRANCAS ST 300 | ||||||||
| Address2: | |||||||||
| City: | NAPA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945582921 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074929236 | ||||||||
| FaxNumber: | 4259495377 | ||||||||
| Practice Location | |||||||||
| Address1: | 1141 PEAR TREE LN | ||||||||
| Address2: | |||||||||
| City: | NAPA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94558 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074929236 | ||||||||
| FaxNumber: | 7072512993 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2007 | ||||||||
| LastUpdateDate: | 09/28/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA19401 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.