Healthcare Provider Details

I. General information

NPI: 1699937565
Provider Name (Legal Business Name): CHERYL ANN MCDONALD R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2008
Last Update Date: 07/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23704 BELLA VISTA RD
CORONA CA
92883-9268
US

IV. Provider business mailing address

23704 BELLA VISTA RD
CORONA CA
92883-9268
US

V. Phone/Fax

Practice location:
  • Phone: 951-277-1746
  • Fax:
Mailing address:
  • Phone: 951-277-1746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number663194
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: