Healthcare Provider Details

I. General information

NPI: 1861006223
Provider Name (Legal Business Name): MONSHITA MCDONALD FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2020
Last Update Date: 11/27/2023
Certification Date: 08/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1523 SAN BERNARDINO WAY
VALDOSTA GA
31601-2511
US

IV. Provider business mailing address

1523 SAN BERNARDINO WAY
VALDOSTA GA
31601-2511
US

V. Phone/Fax

Practice location:
  • Phone: 229-942-9618
  • Fax:
Mailing address:
  • Phone: 229-942-9618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License NumberRN214566
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: