Provider Demographics
NPI:1750721312
Name:CARTER-DONOVAN, PRUDY L (NP-C)
Entity type:Individual
Prefix:MS
First Name:PRUDY
Middle Name:L
Last Name:CARTER-DONOVAN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 INDIAN HILL RD
Mailing Address - Street 2:
Mailing Address - City:VINEYARD HAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02568-7107
Mailing Address - Country:US
Mailing Address - Phone:508-245-8589
Mailing Address - Fax:
Practice Address - Street 1:1 HOSPITAL ROAD
Practice Address - Street 2:
Practice Address - City:OAK BLUFFS
Practice Address - State:MA
Practice Address - Zip Code:02557
Practice Address - Country:US
Practice Address - Phone:508-693-3164
Practice Address - Fax:508-696-5238
Is Sole Proprietor?:No
Enumeration Date:2013-06-27
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA216938363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily