Provider Demographics
NPI:1992980106
Name:DONNELLY, THERESE MARIE GOLINGAY (NP)
Entity type:Individual
Prefix:
First Name:THERESE MARIE
Middle Name:GOLINGAY
Last Name:DONNELLY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:THERESE MARIE
Other - Middle Name:ECHAVIA
Other - Last Name:GOLINGAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:16730 BLACKHAWK ST
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-6543
Mailing Address - Country:US
Mailing Address - Phone:818-217-4963
Mailing Address - Fax:
Practice Address - Street 1:2025 NORTH GLENOAKS BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91504
Practice Address - Country:US
Practice Address - Phone:818-559-1550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-07
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP 16490363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANP 16490OtherNURSE PRACTITIONER LICENC
CARN 596268OtherREGISTERED NURSE LICENSE