MEDICARE: TONY MICHELLE MCDONALD RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN694595	PA

General Provider Information

NPI Number	:	1023651387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TONY MICHELLE MCDONALD RN

Provider Business Mailing Address
First Line	:	115 E 21ST AVE
Second Line	:
City	:	MUNHALL
State	:	PA
Zip	:	15120-2521
Country	:	US
Telephone Number	:	412-853-0728
Fax Number	:

Provider Business Practice Location Address
First Line	:	115 E 21ST AVE
Second Line	:
City	:	MUNHALL
State	:	PA
Zip	:	15120-2521
Country	:	US
Telephone Number	:	412-853-0728
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2019
Last Update Date	:	10/18/2019

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