=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952300519
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LOIS REBECCA MCDONALD CLINICAL NURSE SPECI
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/17/2005
-----------------------------------------------------
Last Update Date | 06/19/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 129 E. GERMAN ST. OFFICE #206
-----------------------------------------------------
City | SHEPERDSTOWN
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25443
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-886-8314
-----------------------------------------------------
Fax | 304-876-2939
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 79
-----------------------------------------------------
City | HARPERS FERRY
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25425
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-886-8314
-----------------------------------------------------
Fax | 304-876-2939
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 364SP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Clinical Nurse Specialist
-----------------------------------------------------
License Number | 28884
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------