Provider Demographics
NPI:1770155749
Name:MACDONALD, AUSTIN SCOTT (RN)
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:SCOTT
Last Name:MACDONALD
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29188 LANCASTER DR APT 206
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1442
Mailing Address - Country:US
Mailing Address - Phone:810-623-7078
Mailing Address - Fax:
Practice Address - Street 1:29188 LANCASTER DR APT 206
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1442
Practice Address - Country:US
Practice Address - Phone:810-623-7078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-10
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704321259163W00000X
MI1770155749367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse