=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588733554
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARGARET A MACDONALD CPNP, PMHNP, EDD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/06/2006
-----------------------------------------------------
Last Update Date | 10/08/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3322 S WATER AVE
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97239-4634
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-452-4500
-----------------------------------------------------
Fax | 503-452-4500
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3322 S WATER AVE
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97239-4634
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-452-4500
-----------------------------------------------------
Fax | 503-452-4501
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 092006922N2
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------