Provider Demographics
NPI:1346544699
Name:MCDONALD, SAMANTHA L (CRNP)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:L
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 1:501 W SEVENTH ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-4586
Mailing Address - Country:US
Mailing Address - Phone:301-694-5861
Mailing Address - Fax:
Practice Address - Street 1:501 W SEVENTH ST
Practice Address - Street 2:SUITE D
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-4586
Practice Address - Country:US
Practice Address - Phone:301-694-5861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-30
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR171140363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care