Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 341811 | NY |
NPI | 1003325630 |
---|---|
Provider Name | Michele Rene Mcdonald |
First Address | Elbridge, NY 13060-9780 |
Second Address | Syracuse, NY 13210-2716 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2017 |
Last Update Date | 27/09/2017 |