Provider Demographics
NPI:1437357241
Name:MCDONALD, JANINE MARIE (ARNP)
Entity Type:Individual
Prefix:MS
First Name:JANINE
Middle Name:MARIE
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3534 S 6000 W
Mailing Address - Street 2:
Mailing Address - City:WEST VALLEY
Mailing Address - State:UT
Mailing Address - Zip Code:84128-2610
Mailing Address - Country:US
Mailing Address - Phone:801-969-6264
Mailing Address - Fax:801-969-6333
Practice Address - Street 1:3534 S 6000 W
Practice Address - Street 2:
Practice Address - City:WEST VALLEY
Practice Address - State:UT
Practice Address - Zip Code:84128-2610
Practice Address - Country:US
Practice Address - Phone:801-969-6264
Practice Address - Fax:801-969-6333
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30007530363L00000X
UT206559-4405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7922404Medicaid
UT1437357241Medicaid
WA7148406Medicaid