Provider Demographics
NPI:1609639533
Name:MACDONALD, CAROL L
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:L
Last Name:MACDONALD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 192
Mailing Address - Street 2:
Mailing Address - City:HOOSICK FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12090-0192
Mailing Address - Country:US
Mailing Address - Phone:518-686-7012
Mailing Address - Fax:518-686-7371
Practice Address - Street 1:21187 NY22
Practice Address - Street 2:
Practice Address - City:HOOSICK FALLS
Practice Address - State:NY
Practice Address - Zip Code:12090
Practice Address - Country:US
Practice Address - Phone:518-686-7012
Practice Address - Fax:518-686-7371
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-02
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY416364-01163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool