Provider Demographics
NPI:1124652284
Name:MCDONALD, QUIEBONNIE M (APRN)
Entity type:Individual
Prefix:MRS
First Name:QUIEBONNIE
Middle Name:M
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3330 WILKENS AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-4610
Mailing Address - Country:US
Mailing Address - Phone:410-525-1544
Mailing Address - Fax:410-525-3146
Practice Address - Street 1:3330 WILKENS AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-4610
Practice Address - Country:US
Practice Address - Phone:410-525-1544
Practice Address - Fax:410-525-3146
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-27
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR196487363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily