Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 1-062972 | AL |
N | 363LP2300X | Nurse Practitioner - Primary Care | 1-062972 | AL |
NPI | 1063783744 |
---|---|
Provider Name | Mrs. Nancy Mcdonald |
First Address | Opelika, AL 36801-5452 |
Second Address | Opelika, AL 36801-5452 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2012 |
Last Update Date | 01/08/2014 |