Provider Demographics
NPI:1700552833
Name:MCDONALD, STEPHANIE NICHOLE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:NICHOLE
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17070 W WALBRIDGE EAST RD
Mailing Address - Street 2:
Mailing Address - City:GRAYTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:43432-9749
Mailing Address - Country:US
Mailing Address - Phone:419-862-3832
Mailing Address - Fax:
Practice Address - Street 1:5206 MONROE ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-4607
Practice Address - Country:US
Practice Address - Phone:567-206-0020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0028672363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily