Provider Demographics
NPI:1568633584
Name:MCDONNELL, DANIEL (MSN PMH-NP)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:
Last Name:MCDONNELL
Suffix:
Gender:M
Credentials:MSN PMH-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 NW HAWTHORNE AVE
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-1400
Mailing Address - Country:US
Mailing Address - Phone:541-417-3455
Mailing Address - Fax:541-471-1439
Practice Address - Street 1:1701 NW HAWTHORNE AVE
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-1400
Practice Address - Country:US
Practice Address - Phone:541-417-3455
Practice Address - Fax:541-471-1439
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-18
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN 732662163WP0807X, 163WP0809X
IL041330155163WP0808X
OR200943049RN163WP0808X
CANP 18356363LP0808X
OR200950161NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult