Provider Demographics
NPI:1861864415
Name:MACDONALD, STEPHANIE (FNP-C)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:MACDONALD
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 46TH AVE SE STE 201
Mailing Address - Street 2:
Mailing Address - City:MANDAN
Mailing Address - State:ND
Mailing Address - Zip Code:58554-4829
Mailing Address - Country:US
Mailing Address - Phone:701-699-4052
Mailing Address - Fax:701-989-7030
Practice Address - Street 1:2401 46TH AVE SE STE 201
Practice Address - Street 2:
Practice Address - City:MANDAN
Practice Address - State:ND
Practice Address - Zip Code:58554-4829
Practice Address - Country:US
Practice Address - Phone:701-699-4052
Practice Address - Fax:701-989-7030
Is Sole Proprietor?:No
Enumeration Date:2015-10-22
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR36302363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily