Provider Demographics
NPI:1790225969
Name:MCDONALD, CONNIE (CNP)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1661 STATE ROUTE 522
Mailing Address - Street 2:UNIT 2
Mailing Address - City:WHEELERSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45694-8120
Mailing Address - Country:US
Mailing Address - Phone:740-574-8728
Mailing Address - Fax:740-574-8918
Practice Address - Street 1:1661 STATE ROUTE 522
Practice Address - Street 2:UNIT 2
Practice Address - City:WHEELERSBURG
Practice Address - State:OH
Practice Address - Zip Code:45694-8120
Practice Address - Country:US
Practice Address - Phone:740-574-8728
Practice Address - Fax:740-574-8918
Is Sole Proprietor?:No
Enumeration Date:2017-03-07
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.020430363LF0000X
KYARNP 3011028363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily