Provider Demographics
NPI:1982434627
Name:DONNELLY, CHRISTOPHER W
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:W
Last Name:DONNELLY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12009 N WASHBED DR
Mailing Address - Street 2:
Mailing Address - City:ORO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85755-8760
Mailing Address - Country:US
Mailing Address - Phone:720-560-1709
Mailing Address - Fax:
Practice Address - Street 1:3777 E GOLDER RANCH DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85739-9747
Practice Address - Country:US
Practice Address - Phone:520-685-7330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-06
Last Update Date:2025-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ230218363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care