Provider Demographics
NPI:1578195152
Name:MCDONALD, AMBER (CRNP)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 FITNESS WAY STE 1200
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:AL
Mailing Address - Zip Code:35611-2492
Mailing Address - Country:US
Mailing Address - Phone:256-236-0636
Mailing Address - Fax:256-232-1281
Practice Address - Street 1:101 FITNESS WAY STE 1200
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35611-2492
Practice Address - Country:US
Practice Address - Phone:256-236-0636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-11
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL172482363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily