Provider Demographics
NPI:1194432245
Name:MCDONALD, JONATHAN EDWARD (RN)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:EDWARD
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 STAFFORDSHIRE CT
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16127-4454
Mailing Address - Country:US
Mailing Address - Phone:814-549-0612
Mailing Address - Fax:
Practice Address - Street 1:64 STAFFORDSHIRE CT
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:PA
Practice Address - Zip Code:16127-4454
Practice Address - Country:US
Practice Address - Phone:814-549-0612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-28
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN578870163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care