Provider Demographics
NPI:1497157440
Name:MCDONALD, MARY HELEN (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:HELEN
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HARRISON
Mailing Address - State:NY
Mailing Address - Zip Code:10604-3910
Mailing Address - Country:US
Mailing Address - Phone:914-368-8153
Mailing Address - Fax:
Practice Address - Street 1:75 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:WEST HARRISON
Practice Address - State:NY
Practice Address - Zip Code:10604-3910
Practice Address - Country:US
Practice Address - Phone:914-368-8153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-22
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4606571163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse