Provider Demographics
NPI:1952300519
Name:MCDONALD, LOIS REBECCA (CLINICAL NURSE SPECI)
Entity type:Individual
Prefix:
First Name:LOIS
Middle Name:REBECCA
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:CLINICAL NURSE SPECI
Other - Prefix:
Other - First Name:LOIS
Other - Middle Name:R
Other - Last Name:MCDONALD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD,APRN,BC
Mailing Address - Street 1:PO BOX 79
Mailing Address - Street 2:
Mailing Address - City:HARPERS FERRY
Mailing Address - State:WV
Mailing Address - Zip Code:25425
Mailing Address - Country:US
Mailing Address - Phone:304-886-8314
Mailing Address - Fax:304-876-2939
Practice Address - Street 1:129 E. GERMAN ST.
Practice Address - Street 2:OFFICE #206
Practice Address - City:SHEPERDSTOWN
Practice Address - State:WV
Practice Address - Zip Code:25443
Practice Address - Country:US
Practice Address - Phone:304-886-8314
Practice Address - Fax:304-876-2939
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-17
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV28884364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810000612Medicaid
WVMC2020691Medicare ID - Type Unspecified
WV3810000612Medicaid