Healthcare Provider Details

I. General information

NPI: 1730765579
Provider Name (Legal Business Name): HANORAH BRIGHID MCDONALD FNP AGACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2021
Last Update Date: 03/22/2021
Certification Date: 03/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

712 JAY ST
FOSSIL OR
97830-8371
US

IV. Provider business mailing address

PO BOX 141
CONDON OR
97823-0141
US

V. Phone/Fax

Practice location:
  • Phone: 541-763-2725
  • Fax:
Mailing address:
  • Phone: 541-384-2287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number202011101NP-PP
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier202011101NP-PP
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerFNP LICENSE
# 2
Identifier202011100NP-PP
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerAGACNP LICENSE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: