Provider Demographics
NPI:1225208861
Name:MCDONALD, ANITA C (CRNP)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:C
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2587
Mailing Address - Street 2:
Mailing Address - City:MUSCLE SHOALS
Mailing Address - State:AL
Mailing Address - Zip Code:35662-2587
Mailing Address - Country:US
Mailing Address - Phone:256-383-4473
Mailing Address - Fax:256-248-4381
Practice Address - Street 1:1404 E AVALON AVE
Practice Address - Street 2:WING B
Practice Address - City:TUSCUMBIA
Practice Address - State:AL
Practice Address - Zip Code:35674-1773
Practice Address - Country:US
Practice Address - Phone:256-383-4473
Practice Address - Fax:256-248-4381
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-11
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1036933363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALI067OtherMEDICARE GROUP
ALDQ0679OtherRAILROAD MEDICARE GROUP