Provider Demographics
NPI:1184661431
Name:MCDONALD, JOAN (ANP)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3875 W SUNSET AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-4959
Mailing Address - Country:US
Mailing Address - Phone:479-751-9236
Mailing Address - Fax:
Practice Address - Street 1:3875 W SUNSET AVE
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-4959
Practice Address - Country:US
Practice Address - Phone:479-751-9236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA01193ANP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARR61013Medicare UPIN
AR5S867Medicare PIN