Provider Demographics
NPI:1245453885
Name:MCDONALD, NANCY ANN (PAC)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:ANN
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:PAC
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Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:374 E GRAND AVE
Mailing Address - Street 2:STUDENT HEALTH CENTER BUILDING # 0269
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62901
Mailing Address - Country:US
Mailing Address - Phone:618-453-3311
Mailing Address - Fax:618-453-4479
Practice Address - Street 1:374 E GRAND AVE
Practice Address - Street 2:STUDENT HEALTH CENTER MAILCODE 6740
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901
Practice Address - Country:US
Practice Address - Phone:618-453-3311
Practice Address - Fax:618-453-4479
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant