Provider Demographics
NPI:1689215923
Name:MACDONALD, CLARE
Entity Type:Individual
Prefix:
First Name:CLARE
Middle Name:
Last Name:MACDONALD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CLARE
Other - Middle Name:
Other - Last Name:MCANDREWS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:503 3RD ST
Mailing Address - Street 2:
Mailing Address - City:KALONA
Mailing Address - State:IA
Mailing Address - Zip Code:52247-9526
Mailing Address - Country:US
Mailing Address - Phone:319-656-3151
Mailing Address - Fax:
Practice Address - Street 1:503 3RD ST
Practice Address - Street 2:
Practice Address - City:KALONA
Practice Address - State:IA
Practice Address - Zip Code:52247-9526
Practice Address - Country:US
Practice Address - Phone:319-656-3151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-07
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.1655283163W00000X
IA157009163W00000X
COAPN.0995075-NP363LF0000X
IAA157009363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse