Provider Demographics
NPI:1437790862
Name:MCDONALD, JAYD
Entity Type:Individual
Prefix:
First Name:JAYD
Middle Name:
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 FLATEN AVE
Mailing Address - Street 2:
Mailing Address - City:GERING
Mailing Address - State:NE
Mailing Address - Zip Code:69341-1850
Mailing Address - Country:US
Mailing Address - Phone:308-436-5555
Mailing Address - Fax:308-436-4352
Practice Address - Street 1:1900 FLATEN AVE
Practice Address - Street 2:
Practice Address - City:GERING
Practice Address - State:NE
Practice Address - Zip Code:69341-1850
Practice Address - Country:US
Practice Address - Phone:308-436-5555
Practice Address - Fax:308-436-4352
Is Sole Proprietor?:No
Enumeration Date:2019-10-07
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47-6005311Medicaid