Provider Demographics
NPI:1831457654
Name:MACDONALD, JOANNE AGNES (RN)
Entity Type:Individual
Prefix:MRS
First Name:JOANNE
Middle Name:AGNES
Last Name:MACDONALD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1780 OCEAN AVE
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-5401
Mailing Address - Country:US
Mailing Address - Phone:718-758-7638
Mailing Address - Fax:718-758-7607
Practice Address - Street 1:1780 OCEAN AVE
Practice Address - Street 2:4TH FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-5401
Practice Address - Country:US
Practice Address - Phone:718-758-7638
Practice Address - Fax:718-758-7607
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-30
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY322830163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse