Provider Demographics
NPI:1104178748
Name:MCDONALD, ALEXANDRA NICOLE
Entity Type:Individual
Prefix:MS
First Name:ALEXANDRA
Middle Name:NICOLE
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3326 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:BELLWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60104-2160
Mailing Address - Country:US
Mailing Address - Phone:773-209-5988
Mailing Address - Fax:
Practice Address - Street 1:3326 MONROE ST
Practice Address - Street 2:
Practice Address - City:BELLWOOD
Practice Address - State:IL
Practice Address - Zip Code:60104-2160
Practice Address - Country:US
Practice Address - Phone:773-209-5988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-05
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.363934163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse