Provider Demographics
NPI:1952855066
Name:MACDONALD-MALCOLM, LINDA M (FNP)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:M
Last Name:MACDONALD-MALCOLM
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:LINDA
Other - Middle Name:M
Other - Last Name:MALCOLM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:5 RICO DR
Mailing Address - Street 2:
Mailing Address - City:NEW WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:12553-5946
Mailing Address - Country:US
Mailing Address - Phone:845-216-3350
Mailing Address - Fax:
Practice Address - Street 1:3584 JEROME AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-1006
Practice Address - Country:US
Practice Address - Phone:718-231-4443
Practice Address - Fax:718-708-4821
Is Sole Proprietor?:No
Enumeration Date:2016-08-05
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY340872363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily