Healthcare Provider Details

I. General information

NPI: 1942185996
Provider Name (Legal Business Name): NICOLE MACDONALD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2025
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 THUNDERBIRD PKWY SW APT S3
LAKEWOOD WA
98498-6113
US

IV. Provider business mailing address

40 THUNDERBIRD PKWY SW APT S3
LAKEWOOD WA
98498-6113
US

V. Phone/Fax

Practice location:
  • Phone: 253-651-3691
  • Fax:
Mailing address:
  • Phone: 253-651-3691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: