Provider Demographics
NPI:1689291825
Name:MCDONALD, ENDIA V (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:ENDIA
Middle Name:V
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4753 N. BROADWAY STREET, SUITE 900, 910, 925
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640
Mailing Address - Country:US
Mailing Address - Phone:773-989-2780
Mailing Address - Fax:773-989-2781
Practice Address - Street 1:4753 N. BROADWAY STREET SUITES 900, 910, 925
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640
Practice Address - Country:US
Practice Address - Phone:773-989-2780
Practice Address - Fax:773-989-2781
Is Sole Proprietor?:No
Enumeration Date:2020-07-04
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041449535163W00000X
IL209024900363L00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner