Provider Demographics
NPI:1396390332
Name:MACDONALD, MARILYN JEAN
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:JEAN
Last Name:MACDONALD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9760 RANCHO HILLS DR
Mailing Address - Street 2:
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-8312
Mailing Address - Country:US
Mailing Address - Phone:408-842-8447
Mailing Address - Fax:
Practice Address - Street 1:9760 RANCHO HILLS DR
Practice Address - Street 2:
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-8312
Practice Address - Country:US
Practice Address - Phone:408-842-8447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-06
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide