Active NPI
Mariaeugenia Sierra-Donovan, PA
- Physician Assistant
- Fort Stewart, GA
National Provider Identifier
1053643593
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 0010-02159
- Practice address
- Winn Army Community Hospital
1061 Harmon Ave
Fort Stewart, GA 31314 - Phone
- (910) 818-6396
- NPI assigned
- Feb 9, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 0010-02159 | NC | Primary |
Addresses
Primary practice location
Winn Army Community Hospital
1061 Harmon Ave
Fort Stewart, GA 31314
Mailing address
Winn Army Community Hospital
1061 Harmon Ave
Fort Stewart, GA 31314
Phone (910) 818-6396
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PENDING | Medicaid | NC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0010-02159 | NC | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1265673600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1581638400000",
"number": "1053643593",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "WINN ARMY COMMUNITY HOSPITAL",
"address_2": "1061 HARMON AVE",
"city": "FORT STEWART",
"state": "GA",
"postal_code": "31314",
"telephone_number": "910-818-6396"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "WINN ARMY COMMUNITY HOSPITAL",
"address_2": "1061 HARMON AVE",
"city": "FORT STEWART",
"state": "GA",
"postal_code": "31314",
"telephone_number": "910-818-6396"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SIERRA-DONOVAN",
"first_name": "MARIAEUGENIA",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-02-09",
"last_updated": "2020-02-14",
"certification_date": "2020-02-14",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NC",
"license": "0010-02159",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "PENDING",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fort Stewart, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.