Healthcare Provider Details

I. General information

NPI: 1770172587
Provider Name (Legal Business Name): LEEANNA BERYL MCDONALD FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LEEANNA MCFARLAND

II. Dates (important events)

Enumeration Date: 01/15/2021
Last Update Date: 08/17/2021
Certification Date: 08/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8401 MARKET ST
BOARDMAN OH
44512-6725
US

IV. Provider business mailing address

8401 MARKET ST
BOARDMAN OH
44512-6725
US

V. Phone/Fax

Practice location:
  • Phone: 330-729-4298
  • Fax: 330-729-1897
Mailing address:
  • Phone: 330-729-4298
  • Fax: 330-729-1897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0028166
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: