Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | APRN9253571 | FL |
NPI | 1033268677 |
---|---|
Provider Name | Mrs. Merlyn M Mcdonald |
First Address | Rockledge, FL 32955-4306 |
Second Address | Melbourne, FL 32901-1973 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2007 |
Last Update Date | 10/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003250100 | (05) | FL |
AA627ZW | MEDICARE (01) | FL |
P01833854 | FL RR MEDICARE (01) | FL |
Q75193 | (02) | FL |