| Doctor Name: | LEE ANN HERTZOG DONOVAN |
| NPI Number: | 1376516831 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CPNP |
| License Number: | R1497120 |
| Business Practice Address: | 250 N Central Ave #101 Wayzata, MN - 55391 |
| Business Phone Number: | 9524730211 |
| Business Fax Number: | 9524737908 |
| Mailing Address: | 250 N Central Ave, #101 WAYZATA |
| State: | MN |
| Postal Code: | 55391 |
| Phone Number: | 9524730211 |
| Fax Number: | 9524737908 |
| NPI Enumeration Date: | 02/07/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WP0200X |
| License Number: | R1497120 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Pediatrics |
| Taxonomy Definition: | |