Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | RN214566 | GA |
NPI | 1861006223 |
---|---|
Provider Name | Ms. Monshita Mcdonald |
First Address | Valdosta, GA 31601-2511 |
Second Address | Valdosta, GA 31601-2511 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/09/2020 |
Last Update Date | 03/09/2020 |