Provider Demographics
NPI:1396235370
Name:DONOGHUE, KATIE M
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:M
Last Name:DONOGHUE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30333 197TH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NE
Mailing Address - Zip Code:68601-6349
Mailing Address - Country:US
Mailing Address - Phone:402-270-4615
Mailing Address - Fax:
Practice Address - Street 1:30333 197TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601-6349
Practice Address - Country:US
Practice Address - Phone:402-270-4615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-15
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer