Provider Demographics
NPI:1528233145
Name:MCDONALD, TONYA ELAINE (LPN)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:ELAINE
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 DOUGLAS ST
Mailing Address - Street 2:APT 2
Mailing Address - City:SURACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13203
Mailing Address - Country:US
Mailing Address - Phone:315-472-1469
Mailing Address - Fax:
Practice Address - Street 1:107 DOUGLAS ST
Practice Address - Street 2:APT 2
Practice Address - City:SURACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203
Practice Address - Country:US
Practice Address - Phone:315-472-1469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2922081164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse