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General NPI Number Information
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NPI Number | 1144605528
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Entity Type | Individual
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Provider Name | JENNIFER MACDONALD
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Gender | Female
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Dates
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Enumeration Date | 07/27/2015
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Last Update Date | 01/22/2019
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Provider Practice Location Address
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Address Line | 979 ROLLING HILLS DR
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86406-8575
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Country | US
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Telephone | 207-907-9270
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1599 PENOBSCOT COMMUNITY HEALTH CENTER
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City | BANGOR
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State | ME
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Zip | 04402-1599
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Country | US
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Telephone |
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | CNP151091
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP10815
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN62458
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License Number State | ME
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