Provider Demographics
NPI:1295471969
Name:MCDONALD, JANUARY SKY (CNM)
Entity Type:Individual
Prefix:
First Name:JANUARY
Middle Name:SKY
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4606 LIBERTY RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44121-3845
Mailing Address - Country:US
Mailing Address - Phone:216-406-3804
Mailing Address - Fax:
Practice Address - Street 1:6620 PARKDALE PL STE K
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-4697
Practice Address - Country:US
Practice Address - Phone:317-437-3681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-06
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN09000398A367A00000X
367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife