Provider Demographics
NPI:1982315636
Name:MCDONALD, REBECCA ANN (FNP- BC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANN
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:FNP- BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3313 W CHERRY LN STE 1069
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642
Mailing Address - Country:US
Mailing Address - Phone:208-291-5553
Mailing Address - Fax:
Practice Address - Street 1:1015 CALDWELL BLVD STE 3
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-1717
Practice Address - Country:US
Practice Address - Phone:208-291-5553
Practice Address - Fax:208-231-9958
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-13
Last Update Date:2024-03-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ID74675363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily