Provider Demographics
NPI:1790483584
Name:MACDONALD, AMELIA LOUISE PEARL (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:AMELIA LOUISE
Middle Name:PEARL
Last Name:MACDONALD
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:AMELIALOUISE
Other - Middle Name:PEARL
Other - Last Name:BREEZEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3421 AMOUR DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306-8662
Mailing Address - Country:US
Mailing Address - Phone:360-915-2765
Mailing Address - Fax:
Practice Address - Street 1:3421 AMOUR DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28306-8662
Practice Address - Country:US
Practice Address - Phone:360-915-2765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-21
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI101961163W00000X
NC340677163W00000X
NCMACD-4E4T1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse