Provider Demographics
NPI:1346226149
Name:MCDONALD, KATHLEEN (RN APN,C)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:RN APN,C
Other - Prefix:MS
Other - First Name:KATHLEEN
Other - Middle Name:
Other - Last Name:MCDONALD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN APN,C
Mailing Address - Street 1:301 LIPPINCOTT DR
Mailing Address - Street 2:SUITE#410
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4197
Mailing Address - Country:US
Mailing Address - Phone:609-703-3200
Mailing Address - Fax:
Practice Address - Street 1:301 LIPPINCOTT DR
Practice Address - Street 2:SUITE#410
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-4197
Practice Address - Country:US
Practice Address - Phone:609-703-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26N005361800363L00000X
NJ26NN05361800363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6664806Medicaid
NJ6664806Medicaid
NJ502788CPPMedicare PIN