1083614846 NPI number — LAURA M MCDONALD CRNP

Table of content: LAURA M MCDONALD CRNP (NPI 1083614846)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083614846 NPI number — LAURA M MCDONALD CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCDONALD
Provider First Name:
LAURA
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SAUNDERS
Provider Other First Name:
LAURA
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CRNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1083614846
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/27/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
490 E NORTH AVE
Provider Second Line Business Mailing Address:
SUITE 307
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15212-4740
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-359-5822
Provider Business Mailing Address Fax Number:
412-359-6620

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
490 E NORTH AVE
Provider Second Line Business Practice Location Address:
SUITE 307
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15212-4740
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-359-5822
Provider Business Practice Location Address Fax Number:
412-359-6620
Provider Enumeration Date:
07/22/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2100X , with the licence number:  UP004374M , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2100X , with the licence number: ARNP9388689 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363L00000X , with the licence number: UP004374M , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1021967980001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".