Healthcare Provider Details

I. General information

NPI: 1538516000
Provider Name (Legal Business Name): JUANITA MCDONNELL PMHNP, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2016
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10154 SPRINGFIELD RD
POLAND OH
44514-3154
US

IV. Provider business mailing address

10154 SPRINGFIELD RD
POLAND OH
44514-3154
US

V. Phone/Fax

Practice location:
  • Phone: 308-810-9393
  • Fax:
Mailing address:
  • Phone: 308-810-9393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number19125-NP
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number121962
License Number StateWV
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024193004
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024193004
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number121962
License Number StateWV
# 6
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number19125
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: