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General NPI Number Information
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NPI Number | 1033908504
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Entity Type | Individual
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Provider Name | NICOLE MCDONALD NP
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Gender | Female
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Dates
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Enumeration Date | 05/02/2025
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Last Update Date | 05/02/2025
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Provider Practice Location Address
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Address Line | 1012 W 11TH ST
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City | UPLAND
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State | CA
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Zip | 91786-3704
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Country | US
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Telephone | 909-244-6177
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Fax |
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Provider Business Mailing Address
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Address Line | 1012 W 11TH ST
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City | UPLAND
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State | CA
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Zip | 91786-3704
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Country | US
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Telephone | 909-244-6177
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 2025007741
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License Number State | CA
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