Healthcare Provider Details

I. General information

NPI: 1992610976
Provider Name (Legal Business Name): LAUREN MACDONALD
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2026
Last Update Date: 08/15/2026
Certification Date: 08/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 CAMPUS RIDGE DR
MIDLAND MI
48640-6139
US

IV. Provider business mailing address

417 E GRAND AVE
MT PLEASANT MI
48858-2013
US

V. Phone/Fax

Practice location:
  • Phone: 989-839-1795
  • Fax: 989-839-1785
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: