Provider Demographics
NPI:1396097622
Name:MCDOUGALD, TONI D (MSN, WHNP-BC)
Entity type:Individual
Prefix:
First Name:TONI
Middle Name:D
Last Name:MCDOUGALD
Suffix:
Gender:F
Credentials:MSN, WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1392 HIGH ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-8257
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1392 HIGH ST
Practice Address - Street 2:SUITE 210
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-8257
Practice Address - Country:US
Practice Address - Phone:999-999-9999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-10
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.13921-NP363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health