Healthcare Provider Details

I. General information

NPI: 1730149758
Provider Name (Legal Business Name): KERRY A MCDONALD NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 12/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 COMPUTER DR STE 301
WESTBOROUGH MA
01581-1790
US

IV. Provider business mailing address

104 LEOMINSTER RD
STERLING MA
01564-2114
US

V. Phone/Fax

Practice location:
  • Phone: 617-420-5316
  • Fax:
Mailing address:
  • Phone: 978-422-7774
  • Fax: 978-422-9089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number252733
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number252733
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: