Provider Demographics
NPI:1689877789
Name:MCDONALD, MARYANN (RN,BSN,MED)
Entity Type:Individual
Prefix:MRS
First Name:MARYANN
Middle Name:
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:RN,BSN,MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 S BODINE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-4207
Mailing Address - Country:US
Mailing Address - Phone:215-467-0920
Mailing Address - Fax:
Practice Address - Street 1:905 S BODINE ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19147-4207
Practice Address - Country:US
Practice Address - Phone:215-467-0920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN282817L163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse