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NPI Code Detail

MEDICARE: ANDREA GRACE MACDONALD NP

MEDICARE: ANDREA GRACE MACDONALD NP
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
1390200000XStudent in an Organized Health Care Education/Training Program
2363LP0808XPsychiatric/Mental Health Nurse Practitioner167934MT

General Provider Information

NPI Number : 1598367781
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREA GRACE MACDONALD NP
Provider Business Mailing Address
First Line : 640 CHINOOK PL
Second Line :
City : BILLINGS
State : MT
Zip : 59102-7032
Country : US
Telephone Number : 406-850-4119
Fax Number :
Provider Business Practice Location Address
First Line : 2950 10TH AVE N
Second Line :
City : BILLINGS
State : MT
Zip : 59101-0720
Country : US
Telephone Number : 406-657-4000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/12/2020
Last Update Date : 12/02/2020

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