Doctor Name: | MS. SUSAN MCDONALD |
NPI Number: | 1073736997 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | CPNP |
License Number: | 543599 |
Business Practice Address: | 1401 S University Dr Nacogdoches, TX - 759616488 |
Business Phone Number: | 9365605668 |
Business Fax Number: | 9365603928 |
Mailing Address: | 1401 S University Dr, P. O. Box 632040 NACOGDOCHES |
State: | TX |
Postal Code: | 759616488 |
Phone Number: | 9365605668 |
Fax Number: | 9365603928 |
NPI Enumeration Date: | 04/10/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LP0200X |
License Number: | 543599 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Pediatrics |
Taxonomy Definition: |