Provider Demographics
NPI:1700453446
Name:MCDONALD, MARKEELA GLORIA
Entity Type:Individual
Prefix:MISS
First Name:MARKEELA
Middle Name:GLORIA
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 1:409 4TH ST N APT 19
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102-4585
Mailing Address - Country:US
Mailing Address - Phone:917-736-8131
Mailing Address - Fax:
Practice Address - Street 1:2100 21ST AVE S APT 102
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-5180
Practice Address - Country:US
Practice Address - Phone:701-306-9610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-10
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant