MEDICARE: KEYWANA M 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	041416582	IL

General Provider Information

NPI Number	:	1336005479
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEYWANA M MCDONALD RN

Provider Business Mailing Address
First Line	:	5201 SYRACUSE CT
Second Line	:
City	:	FAIRVIEW HEIGHTS
State	:	IL
Zip	:	62208-3927
Country	:	US
Telephone Number	:	314-745-2470
Fax Number	:	314-745-2470

Provider Business Practice Location Address
First Line	:	5201 SYRACUSE CT
Second Line	:
City	:	FAIRVIEW HEIGHTS
State	:	IL
Zip	:	62208-3927
Country	:	US
Telephone Number	:	912-591-6823
Fax Number	:

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

Provider Enumeration Date	:	01/02/2026
Last Update Date	:	01/02/2026

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