Provider Demographics
NPI:1700695996
Name:DONOVAN, DARIA ALEKSANDROVNA (PA-C)
Entity type:Individual
Prefix:
First Name:DARIA
Middle Name:ALEKSANDROVNA
Last Name:DONOVAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:DARIA
Other - Middle Name:ALEKSANDROVNA
Other - Last Name:PANTELEEVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:729 WENDOVER BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTON SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:49441-5051
Mailing Address - Country:US
Mailing Address - Phone:443-735-1687
Mailing Address - Fax:
Practice Address - Street 1:1560 E SHERMAN BLVD STE 250
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-1854
Practice Address - Country:US
Practice Address - Phone:231-672-8134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-02
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601012936363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant