Provider Demographics
NPI:1215031422
Name:DONOVAN, RACHEL A (CNM)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:A
Last Name:DONOVAN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 HEBRON AVE STE 113
Mailing Address - Street 2:BALANCED HEALTH CENTER
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-2176
Mailing Address - Country:US
Mailing Address - Phone:860-930-0315
Mailing Address - Fax:860-657-8556
Practice Address - Street 1:300 HEBRON AVE STE 113
Practice Address - Street 2:BALANCED HEALTH CENTER
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-2176
Practice Address - Country:US
Practice Address - Phone:860-930-0315
Practice Address - Fax:860-657-8556
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000139367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004205367Medicaid
NPP000Medicare UPIN
420000049Medicare ID - Type Unspecified