Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | MH-0004 | CT |
NPI | 1043540354 |
---|---|
Provider Name | Jamie Mcdonald |
First Address | Baton Rouge, LA 70816-3254 |
Second Address | Baton Rouge, LA 70816-3254 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2010 |
Last Update Date | 12/03/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00423542 | (05) | MS |
2382004 | (05) | LA |