Provider Demographics
NPI:1881847549
Name:MCDONALD, CAROLYN (ACNP)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 249
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47629-0249
Mailing Address - Country:US
Mailing Address - Phone:812-853-5864
Mailing Address - Fax:
Practice Address - Street 1:10288 W STATE ROUTE 66
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-7952
Practice Address - Country:US
Practice Address - Phone:812-583-5864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN2008007900363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200936920Medicaid
00000609519OtherANTHEM
KY7100085550Medicaid
IN200936920Medicaid
IN210000CMedicare PIN