Provider Demographics
NPI:1366780884
Name:DONOHOUE, MAUREEN (L AC)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:DONOHOUE
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:
Other - First Name:MAUREEN
Other - Middle Name:
Other - Last Name:DONOHOUE HOWELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:L AC
Mailing Address - Street 1:PO BOX 1839
Mailing Address - Street 2:
Mailing Address - City:LANDER
Mailing Address - State:WY
Mailing Address - Zip Code:82520-1839
Mailing Address - Country:US
Mailing Address - Phone:720-220-1632
Mailing Address - Fax:
Practice Address - Street 1:318 MAIN ST
Practice Address - Street 2:
Practice Address - City:LANDER
Practice Address - State:WY
Practice Address - Zip Code:82520-3102
Practice Address - Country:US
Practice Address - Phone:720-220-1632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-17
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO910171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist