Healthcare Provider Details

I. General information

NPI: 1366209827
Provider Name (Legal Business Name): ASHLEY NICOLE MACDONALD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2024
Last Update Date: 03/18/2024
Certification Date: 03/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3086 35TH ST APT 2A
ASTORIA NY
11103-4707
US

IV. Provider business mailing address

3086 35TH ST APT 2A
ASTORIA NY
11103-4707
US

V. Phone/Fax

Practice location:
  • Phone: 631-721-7831
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number311529
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF311529
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: