Basic Information
| Provider Information | |||||||||
| NPI: | 1780856013 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DONOVAN | ||||||||
| FirstName: | KRISTINA | ||||||||
| MiddleName: | JANSSEN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | JANSSEN | ||||||||
| OtherFirstName: | KRISTINA | ||||||||
| OtherMiddleName: | LOUISE | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 4715 WHITESBURG DR SE | ||||||||
| Address2: | |||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358021632 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2568815151 | ||||||||
| FaxNumber: | 2568803939 | ||||||||
| Practice Location | |||||||||
| Address1: | 4715 WHITESBURG DRIVE | ||||||||
| Address2: | SPORTSMED ORTHOPAEDIC SURGERY AND SPINE CENTER | ||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 35802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2568815151 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2008 | ||||||||
| LastUpdateDate: | 08/21/2012 | ||||||||
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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 | 2081P2900X | DO.1109 | AL | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.