Provider Demographics
NPI:1497940779
Name:MCDONALD, LISA (FNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 TAYLOR LN
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-7161
Mailing Address - Country:US
Mailing Address - Phone:518-369-4248
Mailing Address - Fax:
Practice Address - Street 1:1444 MASSACHUSETTS AVE
Practice Address - Street 2:SUITE 209
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-1600
Practice Address - Country:US
Practice Address - Phone:518-273-0280
Practice Address - Fax:518-273-0281
Is Sole Proprietor?:No
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY334093363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily