Healthcare Provider Details

I. General information

NPI: 1043138894
Provider Name (Legal Business Name): JENNA MCDONALD AGCNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 WAKE FOREST RD
RALEIGH NC
27609-7317
US

IV. Provider business mailing address

8205 BELLA OAK CT
WAKE FOREST NC
27587-3396
US

V. Phone/Fax

Practice location:
  • Phone: 240-215-7864
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number625
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: