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General NPI Number Information
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NPI Number | 1881291433
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Entity Type | Individual
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Provider Name | JACQUELINE M MACDONALD APRN, PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 10/07/2020
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Last Update Date | 01/13/2025
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Provider Practice Location Address
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Address Line | 6377 SEBRING WAY
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City | LOVES PARK
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State | IL
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Zip | 61111-8609
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Country | US
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Telephone | 815-986-1113
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Fax |
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Provider Business Mailing Address
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Address Line | 10566 E CEDARVILLE RD
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City | DAVIS
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State | IL
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Zip | 61019-9338
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Country | US
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Telephone | 815-391-0781
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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 | 364SC1501X
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Taxonomy Name | Community Health/Public Health Clinical Nurse Specialist
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License Number | 041413999
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 209031085
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License Number State | IL
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