Provider Demographics
NPI:1063781052
Name:MACDONNA, MICHELLE HYEON (CRNP)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:HYEON
Last Name:MACDONNA
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:HYEON
Other - Last Name:SILAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP, MSN/MPH
Mailing Address - Street 1:1203 CHICOPEE RD
Mailing Address - Street 2:
Mailing Address - City:BENSON
Mailing Address - State:NC
Mailing Address - Zip Code:27504-2121
Mailing Address - Country:US
Mailing Address - Phone:919-207-3205
Mailing Address - Fax:919-207-3105
Practice Address - Street 1:1203 CHICOPEE RD
Practice Address - Street 2:
Practice Address - City:BENSON
Practice Address - State:NC
Practice Address - Zip Code:27504-2121
Practice Address - Country:US
Practice Address - Phone:919-207-3205
Practice Address - Fax:919-207-3105
Is Sole Proprietor?:No
Enumeration Date:2011-12-20
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR154556363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health