Healthcare Provider Details

I. General information

NPI: 1710893938
Provider Name (Legal Business Name): JENNA MCDONALD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 SHARRON AVE
PLATTSBURGH NY
12901-4700
US

IV. Provider business mailing address

79 GLENRIDGE RD
GLENVILLE NY
12302-4523
US

V. Phone/Fax

Practice location:
  • Phone: 518-561-1447
  • Fax: 518-562-8812
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number357361
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: