Provider Demographics
NPI:1538284500
Name:MACDONALD, MARIA HALLIDAY (RN, CCRC)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:HALLIDAY
Last Name:MACDONALD
Suffix:
Gender:F
Credentials:RN, CCRC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:920 EAST 28TH STREET
Mailing Address - Street 2:SUITE 210, MAIL STOP 33210
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407
Mailing Address - Country:US
Mailing Address - Phone:612-863-6051
Mailing Address - Fax:612-863-3771
Practice Address - Street 1:920 E 28TH ST
Practice Address - Street 2:SUITE 210, MAIL STOP 33210
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-1139
Practice Address - Country:US
Practice Address - Phone:612-863-6051
Practice Address - Fax:612-863-3771
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR093299-0163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse