Provider Demographics
NPI:1669526166
Name:MCDONALD, CHRISTINE J
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:J
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4510 NETTLETON RD
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-8142
Mailing Address - Country:US
Mailing Address - Phone:216-406-1635
Mailing Address - Fax:
Practice Address - Street 1:8240 STONE RD
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-8979
Practice Address - Country:US
Practice Address - Phone:330-722-4019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2571515374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide