Provider Demographics
NPI:1386719342
Name:MCAULEY, DONNA SUE (FNP CMW)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:SUE
Last Name:MCAULEY
Suffix:
Gender:F
Credentials:FNP CMW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:686 W LINE ST
Mailing Address - Street 2:
Mailing Address - City:BISHOP
Mailing Address - State:CA
Mailing Address - Zip Code:93514-3315
Mailing Address - Country:US
Mailing Address - Phone:760-872-4311
Mailing Address - Fax:760-872-4130
Practice Address - Street 1:686 W LINE ST
Practice Address - Street 2:
Practice Address - City:BISHOP
Practice Address - State:CA
Practice Address - Zip Code:93514-3315
Practice Address - Country:US
Practice Address - Phone:760-872-4311
Practice Address - Fax:760-872-4130
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5783363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C371720OtherBLUE CROSS
CA366OtherNURSE MIDWIFE
CA00C371720OtherBLUE SHEILD
CA201575OtherREGISTERED NURSE
CAGR0021672Medicaid
CA5783OtherNURSE PRACTITIONER
CA770051426001OtherTRICARE
CARHM53941FMedicaid
CA366OtherNURSE MIDWIFE
CAP19451Medicare UPIN
CA553941Medicare ID - Type UnspecifiedRIVERBEND