Provider Demographics
NPI:1306486030
Name:DONOVAN, ALLISON M
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:M
Last Name:DONOVAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:M
Other - Last Name:WELDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 193
Mailing Address - Street 2:
Mailing Address - City:NORTH LIBERTY
Mailing Address - State:IA
Mailing Address - Zip Code:52317-0193
Mailing Address - Country:US
Mailing Address - Phone:319-499-5410
Mailing Address - Fax:
Practice Address - Street 1:565 CAMERON WAY STE 103
Practice Address - Street 2:
Practice Address - City:NORTH LIBERTY
Practice Address - State:IA
Practice Address - Zip Code:52317-4868
Practice Address - Country:US
Practice Address - Phone:319-499-5410
Practice Address - Fax:877-559-4490
Is Sole Proprietor?:No
Enumeration Date:2020-01-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAG175222363LP0808X
IAA157432363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily