Provider Demographics
NPI:1003284761
Name:MCDONALD, JUDITH LYNN (RN)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:LYNN
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5406 TEMPLE CT
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-2650
Mailing Address - Country:US
Mailing Address - Phone:608-358-4932
Mailing Address - Fax:
Practice Address - Street 1:6205 DOMINION DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53718-3124
Practice Address - Country:US
Practice Address - Phone:262-719-7224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-10
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI81376163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse