Provider Demographics
NPI:1003918103
Name:MCDONALD, RHEANNON JANELL (PA)
Entity Type:Individual
Prefix:
First Name:RHEANNON
Middle Name:JANELL
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:3452 GENESYS PKWY
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-7334
Mailing Address - Country:US
Mailing Address - Phone:810-606-7550
Mailing Address - Fax:810-606-6235
Practice Address - Street 1:445 N FENWAY DR
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-2666
Practice Address - Country:US
Practice Address - Phone:810-750-6060
Practice Address - Fax:810-750-6081
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2021-03-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5601004413363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant