Healthcare Provider Details

I. General information

NPI: 1366925281
Provider Name (Legal Business Name): MADISON MARIE MCDONALD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2018
Last Update Date: 09/20/2024
Certification Date: 09/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 W 5TH AVE STE 800
SPOKANE WA
99204-2912
US

IV. Provider business mailing address

7707 N FOX POINT DR
SPOKANE WA
99208-6325
US

V. Phone/Fax

Practice location:
  • Phone: 509-755-5120
  • Fax: 509-342-2272
Mailing address:
  • Phone: 253-302-7995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA60976632
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: