Provider Demographics
NPI:1912787466
Name:MCDONALD, ISABELLA ROSE (WHNP-BC)
Entity Type:Individual
Prefix:
First Name:ISABELLA
Middle Name:ROSE
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 RIVERVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-3817
Mailing Address - Country:US
Mailing Address - Phone:781-367-1299
Mailing Address - Fax:
Practice Address - Street 1:23 RIVERVIEW AVE
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-3817
Practice Address - Country:US
Practice Address - Phone:781-367-1299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-03
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2361598163WG0000X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice