Provider Demographics
NPI:1427289586
Name:MACDONALD, PATRICIA R (MSN, FNP)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:R
Last Name:MACDONALD
Suffix:
Gender:F
Credentials:MSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:464 ROUTE 25A
Mailing Address - Street 2:
Mailing Address - City:MILLER PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11764-2514
Mailing Address - Country:US
Mailing Address - Phone:631-642-2200
Mailing Address - Fax:631-642-2195
Practice Address - Street 1:464 ROUTE 25A
Practice Address - Street 2:
Practice Address - City:MILLER PLACE
Practice Address - State:NY
Practice Address - Zip Code:11764-2514
Practice Address - Country:US
Practice Address - Phone:631-642-2200
Practice Address - Fax:631-642-2195
Is Sole Proprietor?:No
Enumeration Date:2009-08-06
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF-336045-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily