Provider Demographics
NPI:1457662348
Name:MCDONALD, MARIANN L (RN)
Entity Type:Individual
Prefix:MS
First Name:MARIANN
Middle Name:L
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2511 E BELLEVIEW PLACE
Mailing Address - Street 2:APT. D
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53211
Mailing Address - Country:US
Mailing Address - Phone:715-891-5641
Mailing Address - Fax:
Practice Address - Street 1:2511 E BELLEVIEW PLACE
Practice Address - Street 2:APT. D
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211
Practice Address - Country:US
Practice Address - Phone:715-891-5641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-25
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI173093-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse