Healthcare Provider Details

I. General information

NPI: 1891214599
Provider Name (Legal Business Name): NANCY LEE MCDONALD CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2017
Last Update Date: 09/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 SOUT TUSTIN
ORANGE CA
92866
US

IV. Provider business mailing address

24 BLUEBIRD LN
ALISO VIEJO CA
92656-1761
US

V. Phone/Fax

Practice location:
  • Phone: 714-922-4100
  • Fax:
Mailing address:
  • Phone: 949-215-4062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number350038
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: