Provider Demographics
NPI:1033101209
Name:MACDONALD, DEBRA K (ARNP)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:K
Last Name:MACDONALD
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1033 COUNTRY CT
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-9500
Mailing Address - Country:US
Mailing Address - Phone:509-628-1363
Mailing Address - Fax:509-628-2207
Practice Address - Street 1:1360 N LOUISIANA ST # A737
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-7171
Practice Address - Country:US
Practice Address - Phone:509-628-1958
Practice Address - Fax:509-628-1959
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200550106NP363LF0000X
WAAP30006509363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP96088Medicare UPIN
WAAB38841Medicare ID - Type UnspecifiedPROVIDER ID NUMBER