Provider Demographics
NPI:1194175893
Name:DONOVAN, MELISSA CAMPBELL (RN, IBCLC)
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:CAMPBELL
Last Name:DONOVAN
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2710 LAKEWIND CT
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-4288
Mailing Address - Country:US
Mailing Address - Phone:404-556-3206
Mailing Address - Fax:
Practice Address - Street 1:2710 LAKEWIND CT
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-4288
Practice Address - Country:US
Practice Address - Phone:404-556-3206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-14
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAL-87069163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant