Provider Demographics
NPI:1356676902
Name:MACDONALD, EWAN STEPHEN (RNFA)
Entity Type:Individual
Prefix:MR
First Name:EWAN
Middle Name:STEPHEN
Last Name:MACDONALD
Suffix:
Gender:M
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 ENSLEN AVE
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-5157
Mailing Address - Country:US
Mailing Address - Phone:209-985-2911
Mailing Address - Fax:
Practice Address - Street 1:1301 ENSLEN AVE
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-5157
Practice Address - Country:US
Practice Address - Phone:209-985-2911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-14
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA384397163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant