Provider Demographics
NPI:1225247836
Name:MCDONALD, MARCIA L S (FNP CNM)
Entity Type:Individual
Prefix:MRS
First Name:MARCIA
Middle Name:L S
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:FNP CNM
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 5468
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95402-5468
Mailing Address - Country:US
Mailing Address - Phone:707-546-7158
Mailing Address - Fax:
Practice Address - Street 1:3536 MENDOCINO AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-3634
Practice Address - Country:US
Practice Address - Phone:707-571-1280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA616363LF0000X
CA216367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife