Basic Information
| Provider Information | |||||||||
| NPI: | 1952055691 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DONAHUE | ||||||||
| FirstName: | MARIANA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | RN | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1500 N 34TH ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | SUPERIOR | ||||||||
| State: | WI | ||||||||
| PostalCode: | 548804476 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7153928216 | ||||||||
| FaxNumber: | 7153926055 | ||||||||
| Practice Location | |||||||||
| Address1: | 1500 N 34TH ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | SUPERIOR | ||||||||
| State: | WI | ||||||||
| PostalCode: | 548804476 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7153928216 | ||||||||
| FaxNumber: | 7153926055 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/11/2022 | ||||||||
| LastUpdateDate: | 02/11/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 02/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0808X | 21661-875 | WI | Y | Nursing Service Providers | Registered Nurse | Psych/Mental Health | 163WP0808X | 2488237 | MN | N | Nursing Service Providers | Registered Nurse | Psych/Mental Health |
No ID Information.